Precision Medicine by targeting VEGF-A variants for treatment of retinopathy

ABSTRACT

The invention relates to human targets of interest (TOI), anti-TOI ligands, kits compositions and method.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No.14/331,730 filed Jul. 15, 2014, the entire content of which isincorporated by reference.

SEQUENCE LISTING

The instant application contains a Sequence Listing which has beensubmitted electronically in ASCII format and is hereby incorporated byreference in its entirety. Said ASCII copy, created on Nov. 7, 2014, isnamed 069496-082993_SEtxt and is 320,546 bytes in size.

TECHNICAL FIELD

The technology described herein relates to ligands, e.g., antibodies forthe treatment of disease.

BACKGROUND

It is recognized that individual humans differ in their sequence andrecently several individuals have had their genomes sequenced, forinstance James Watson and Craig Venter. Comparison of the genomesequence of individuals has revealed differences in their sequences inboth coding and non-coding parts of the genome. Some of these variationsin humans are significant and contribute to phenotypic differencesbetween individuals. In extreme cases these will result in geneticdisease. The 1000 Genomes Project has the objective of cataloguingsequences in the human genome, involving sequencing the genomes of avery large sampling of individuals from diverse art-recognized humanethnic populations.

SUMMARY

Through the application of human genetic variation analysis andrationally-designed sequence selection the present invention providesfor improved human patient diagnosis and therapy. Importantly, theinvention enables tailored medicines that address individual humanpatient genotypes or phenotypes.

The inventor's analysis of large numbers of naturally-occurring genomichuman TOI sequences reveals that there is significant variation acrossdiverse human populations and provides for the ability for correlationbetween individual human patients and tailored medical and diagnosticapproaches addressing the target. The technical applications of thesefindings, as per the present invention, thus contribute to bettertreatment, prophylaxis and diagnosis in humans and provides for patientbenefit by enabling personalized medicines and therapies. This providesadvantages of better prescribing, less wastage of medications andimproved chances of drug efficacy and better diagnosis in patients.

Furthermore, the inventor surprisingly realised that some rarer naturalforms, although present in humans at much lower frequencies than thecommon form, nevertheless are represented in multiple andethnically-diverse human populations and usually with many humanexamples per represented ethnic population. Thus, the inventor realisedthat targeting such rarer forms would provide for effective treatment,prophylaxis or diagnosis across many human ethnic populations, therebyextending the utility of the present invention and better servingpatients in those populations.

With this, the inventor realised that there is significant industrialand medical application for the invention in terms of guiding the choiceof an anti-TOI ligand for administration to human patients for therapyand/or prophylaxis of TOI-mediated or associated diseases andconditions. In this way, the patient receives drugs and ligands that aretailored to their needs—as determined by the patient's genetic orphenotypic makeup. Hand-in-hand with this, the invention provides forthe genotyping and/or phenotyping of patients in connection with suchtreatment, thereby allowing a proper match of drug to patient. Thisincreases the chances of medical efficacy, reduces the likelihood ofinferior treatment using drugs or ligands that are not matched to thepatient (eg, poor efficacy and/or side-effects) and avoidspharmaceutical mis-prescription and waste.

To this end, the invention provides:—

In a First Configuration

A method of treating or preventing a disease or condition in a human,wherein the disease or condition is mediated by a Target of Interest(TOI), wherein the TOI is present in humans as different polymorphicvariants, the method comprising

-   a. Administering to the human an anti-TOI ligand to target a TOI    variant in the human and treat or prevent said disease or condition,    wherein the TOI in said human is encoded by a nucleotide sequence    having a cumulative human allele frequency of less than 50% and/or    wherein the TOI in said human is encoded by a nucleotide sequence    having a total human genotype frequency of less than 50%;

wherein

-   b. Before step (a) said human has been or is genotyped as positive    for said nucleotide sequence or phenotyped as positive for said TOI    variant.

In a Second Configuration

A method of treating or preventing a disease or condition in a human,wherein the disease or condition is mediated by a Target of Interest(TOI), wherein the TOI is present in humans as different polymorphicvariants, the method comprising

-   -   a. Administering to the human an anti-TOI ligand to target a TOI        variant in the human and treat or prevent said disease or        condition, wherein the TOI in said human is encoded by a        nucleotide sequence having a cumulative human allele frequency        of less than 50% and/or wherein the TOI in said human is encoded        by a nucleotide sequence having a total human genotype frequency        of less than 50%; wherein    -   b. before step (a) the ligand has been or is determined as        capable of binding to said TOI variant.

In a Third Configuration

A method of treating or preventing a disease or condition in a human,wherein the disease or condition is mediated by a Target of Interest(TOI), wherein the TOI is present in humans as different polymorphicvariants, the method comprising

-   a. Administering to the human an anti-TOI ligand to target a TOI    variant in the human and treat or prevent said disease or condition,    wherein the TOI in said human is a variant encoded by a nucleotide    sequence having a cumulative human allele frequency of more than 50%    and/or having a total human genotype frequency of more than 50%;    wherein-   b. Before step (a) said human has been or is genotyped as negative    for a variant nucleotide sequence having a cumulative human allele    frequency of less than 50% and/or having a total human genotype    frequency of less than 50%; or phenotyped as negative for a TOI    variant encoded by a nucleotide sequence having a cumulative human    allele frequency of less than 50% and/or having a total human    genotype frequency of less than 50%.

In a Fourth Configuration

An anti-human TOI ligand for use in a method of treating and/orpreventing a TOI-mediated disease or condition in a human, wherein theTOI is present in humans as different polymorphic variants and whereinthe genome of said human comprises a TOI nucleotide sequence having acumulative human allele frequency of less than 50% and/or a total humangenotype frequency of less than 50%, the method comprising administeringthe ligand to the human.

In a Fifth Configuration

A ligand that binds a human TOI comprising an amino acid sequenceencoded by a TOI nucleotide sequence having a cumulative human allelefrequency of less than 50% and/or a total human genotype frequency ofless than 50%, for use in a method comprising the step of using theligand to target said TOI in a human to treat and/or prevent a diseaseor condition mediated by TOI, the method comprising administering theligand to the human.

In a Sixth Configuration

A pharmaceutical composition or kit for treating or preventing acondition or disease mediated by a TOI.

In a Seventh Configuration

A method of producing an anti-human TOI antibody binding site, themethod comprising obtaining a plurality of anti-TOI antibody bindingsites, screening the antibody binding sites for binding to a TOIcomprising an amino acid sequence encoded by a nucleotide sequencehaving a cumulative human allele frequency of less than 50% and/or atotal human genotype frequency of less than 50%, or to a peptide thereofthat comprises an amino acid variation from the corresponding sequenceencoded by the TOI-encoding nucleotide sequence having the highestcumulative human allele frequency and/or the highest total humangenotype frequency, and isolating an antibody binding site that binds inthe screening step.

In a Eighth Configuration

A method of producing an anti-human TOI antibody, the method comprisingimmunising a non-human vertebrate (eg, a mouse or a rat) with a TOIcomprising an amino acid sequence encoded by a nucleotide sequencehaving a cumulative human allele frequency of less than 50% and/or atotal human genotype frequency of less than 50%, or to a peptide thereofthat comprises an amino acid variation from the corresponding sequenceencoded by the TOI-encoding nucleotide sequence having the highestcumulative human allele frequency and/or the highest total humangenotype frequency, and isolating an antibody that binds a TOIcomprising an amino acid sequence encoded by a TOI nucleotide sequencehaving a cumulative human allele frequency of less than 50% and/or atotal human genotype frequency of less than 50%, and optionallyproducing a TOI-binding fragment or derivative of the isolated antibody.

In a Ninth Configuration

A kit for TOI genotyping a human, wherein the kit comprises a nucleicacid comprising a nucleotide sequence that specifically hybridises to aTOI nucleotide sequence selected having a cumulative human allelefrequency of less than 50% and/or a total human genotype frequency ofless than 50% or an RNA transcript thereof and/or the nucleic acidcomprises a nucleotide sequence that comprises at least 10 contiguousnucleotides of a TOI nucleotide sequence having a cumulative humanallele frequency of less than 50% and/or a total human genotypefrequency of less than 50% or is an antisense sequence thereof.

In a Tenth Configuration

Use of an anti-TOI ligand that binds a human TOI comprising an aminoacid sequence encoded by a TOI nucleotide sequence having a cumulativehuman allele frequency of less than 50% and/or a total human genotypefrequency of less than 50%, in the manufacture of a medicament fortreating and/or preventing a TOI-mediated disease or condition in ahuman whose genome comprises a TOI nucleotide sequence having acumulative human allele frequency of less than 50% and/or having a totalhuman genotype frequency of less than 50%.

In a Eleventh Configuration

Use of an anti-TOI ligand that binds a human TOI comprising an aminoacid sequence encoded by a TOI nucleotide sequence having a cumulativehuman allele frequency of less than 50% and/or a total human genotypefrequency of less than 50%, in the manufacture of a medicament fortargeting said TOI in a human to treat and/or prevent a disease orcondition mediated by TOI.

In a Twelfth Configuration

A method of targeting a TOI for treating and/or preventing aTOI-mediated disease or condition in a human, the method comprisingadministering an anti-TOI ligand to a human comprising a TOI nucleotidesequence selected having a cumulative human allele frequency of lessthan 50% and/or a total human genotype frequency of less than 50%,whereby a TOI encoded by said nucleotide sequence is targeted.

In a Thirteenth Configuration

A method of TOI genotyping a nucleic acid sample of a human, the methodcomprising identifying in the sample the presence of a TOI nucleotidesequence having a cumulative human allele frequency of less than 50%and/or having a total human genotype frequency of less than 50%.

In a Fourteenth Configuration

A method of TOI typing a protein sample of a human, the methodcomprising identifying in the sample the presence of a TOI amino acidsequence encoded by a TOI nucleotide sequence having a cumulative humanallele frequency of less than 50% and/or having a total human genotypefrequency of less than 50%.

In an example, the TOI is a human TOI selected from the group consistingof PCSK9, VEGF-A and IL6 receptor. In an example, the TOI is humanIL4Ra, PDGF-B, PDGFR-B or Ang-2.

A Fifteenth Configuration provides a ligand, method, use, kit orcomposition of the invention, wherein

-   (i) the ligand (eg, antibody or fragment) comprises    -   (a) a variable domain that is encoded by a human V region        nucleotide sequence, wherein the V nucleotide sequence is        derived from recombination of human VH, D and JH gene segments        or human VL and JL gene segments; or    -   (b) a constant region domain encoded by a C region gene segment;    -   Wherein a first gene segment of said gene segments of (a), or        said C region gene segment of (b) comprises a first single        nucleotide polymorphism (SNP) encoding a first amino acid        polymorphism; and-   (ii) the genome of said human comprises said first SNP or wherein    said human expresses (a′) an antibody variable domain comprising    said first amino acid polymorphism or (b′) an antibody constant    domain comprising said first amino acid polymorphism.

A Sixteenth Configuration provides the ligand, method, use, kit orcomposition of the invention, wherein the ligand comprises or consistsof an antibody or fragment that comprises a human antibody variabledomain derived from the recombination of a human V gene segment and ahuman J gene segment (and optionally a human D gene segment when thevariable domains are VH domains); and wherein the genome of the humancomprises said human V gene segment and/or the human expressesantibodies comprising antibody variable domains derived from therecombination of said human V gene segment and a human J gene segment(and optionally a human D gene segment).

A Sixteenth Configuration provides the ligand, method, use, kit orcomposition of the invention, wherein the ligand (eg, comprising orconsisting of an antibody or fragment or an Fc-fused human PCSK9receptor) comprises a human heavy chain constant domain encoded by afirst constant region nucleotide sequence; and wherein the genome of thehuman comprises a heavy chain constant region nucleotide sequence thatis identical to said first constant region nucleotide sequence and/orthe human expresses antibodies comprising said human constant domain.

A Seventeenth Configuration provides the ligand, method, use, kit orcomposition of the invention, wherein the ligand (eg, comprising orconsisting of an antibody or fragment or an Fc-fused TOI receptor)comprises a human gamma-1 heavy chain constant region that comprises anAsp corresponding to position 204 of SEQ ID NO: 42 or a Leucorresponding to position 206 of SEQ ID NO: 42 and wherein the genome ofthe human comprises a gamma-1 heavy chain constant region nucleotidesequence that encodes such an Asp or Leu or the human expressesantibodies comprising human gamma-1 constant regions comprising such anAsp or Leu.

A Eighteenth Configuration provides the ligand, method, use, kit orcomposition of the invention, wherein the ligand (eg, comprising orconsisting of an antibody or fragment or an Fe-fused TOI receptor)comprises a human gamma-2 heavy chain constant region that comprises anamino acid selected from the group consisting of a Pro corresponding toposition 72 of SEQ ID NO: 44, an Asn corresponding to position 75 of SEQID NO: 44, a Phe corresponding to position 76 of SEQ ID NO: 44, a Valcorresponding to position 161 of SEQ ID NO: 44 and an Ala correspondingto position 257 of SEQ ID NO: 44; and wherein the genome of the humancomprises a gamma-2 heavy chain constant region nucleotide sequence thatencodes such a selected amino acid or the human expresses antibodiescomprising human gamma-2 constant regions comprising such a selectedamino acid.

A Ninteenth Configuration provides the ligand, method, use, kit orcomposition of the invention, wherein the ligand (eg, comprising orconsisting of an antibody or fragment or an Fc-fused TOI receptor)comprises a human kappa light chain constant region that comprises a Valcorresponding to position 84 of SEQ ID NO: 50 or a Cys corresponding toposition 87 of SEQ ID NO: 50; and wherein the genome of the humancomprises a kappa light chain constant region nucleotide sequence thatencodes such a Val or Cys or the human expresses antibodies comprisinghuman kappa light chain constant regions comprising such a Val or Cys.

A Twentieth Configuration provides the ligand, method, use, kit orcomposition of the invention, wherein the ligand comprises or consistsof an antibody or fragment, wherein the antibody or fragment comprises aVH domain that is derived from the recombination of a human VH genesegment, a human D gene segment and a human JH gene segment, wherein theVH gene segment is selected from the group consisting of (i) IGHV1-18*01and the genome of the human comprises a human IGHV1-18*01 nucleotidesequence or the human expresses antibodies comprising variable domainsderived from the recombination of human IGHV1-18*01; or (ii) IGVH1-46*01and the genome of the human comprises a human IGHV1-46*01 nucleotidesequence or the human expresses antibodies comprising variable domainsderived from the recombination of human IGHV1-46*01.

A Twenty-First Configuration provides the ligand, method, use, kit orcomposition of the invention, wherein the ligand comprises or consistsof an antibody or fragment, wherein the antibody or fragment comprises aVL domain that is derived from the recombination of a human VL genesegment and a human JL gene segment, wherein the VL gene segment isselected from the group consisting of (i) IGKV4-1*01 and the genome ofthe human comprises a human IGKV4-1*01 nucleotide sequence or the humanexpresses antibodies comprising variable domains derived from therecombination of human IGKV4-1*01; (ii) IGLV2-14*01 and the genome ofthe human comprises a human IGLV2-14*01 nucleotide sequence or the humanexpresses antibodies comprising variable domains derived from therecombination of human IGLV2-14*01; or (iii) IGKV1-13*02 and the genomeof the human comprises a human IGKV1-13*02 nucleotide sequence or thehuman expresses antibodies comprising variable domains derived from therecombination of human IGKV1-13*02.

A Twenty-Second Configuration provides a method of treating or reducingthe risk of an IL4Ra-mediated disease or condition in a human in needthereof, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human IL4RAprotein that comprises a mutation selected from the group consisting ofI75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67. Asexplained further below, these amino acid variations are found innaturally-occurring IL-4Ra variants in humans found in many populations.Said human comprises a nucleotide sequence encoding said IL4RA proteincomprising said mutation selected from the group consisting of I75V,E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67.

A Twenty-Third Configuration provides a ligand (eg, an antibody orantibody fragment) for treating or reducing the risk of anIL4Ra-mediated disease or condition in a human in need thereof, themethod comprising administering to said human said ligand, wherein theligand specifically binds a human IL4RA protein that comprises amutation selected from the group consisting of I75V, E400A, C431R,S503P, Q576R and S752A in SEQ ID NO: 67. Said human comprises anucleotide sequence encoding said IL4RA protein comprising said mutationselected from the group consisting of I75V, E400A, C431R, S503P, Q576Rand S752A in SEQ ID NO: 67.

A Twenty-Fourth Configuration provides provides a method of targetingIL4Ra in a human, the method comprising administering to said human aligand (eg, an antibody or antibody fragment) that specifically binds ahuman IL4RA protein that comprises a mutation selected from the groupconsisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO:67. Said human comprises a nucleotide sequence encoding said IL4RAprotein comprising said mutation selected from the group consisting ofI75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67. In anexample, the human is suffering from or at risk of an IL4Ra-mediateddisease or condition. In an example, the method treats or reduces therisk of an IL4Ra-mediated disease or condition in the human.

A Twenty-Fifth Configuration provides a ligand (eg, an antibody orantibody fragment) for targeting IL4Ra in a human, the method comprisingadministering to said human said ligand, wherein the ligand specificallybinds a human IL4RA protein that comprises a mutation selected from thegroup consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ IDNO: 67. Said human comprises a nucleotide sequence encoding said IL4RAprotein comprising said mutation selected from the group consisting ofI75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67. In anexample, the human is suffering from or at risk of an IL4Ra-mediateddisease or condition. In an example, the method treats or reduces therisk of an IL4Ra-mediated disease or condition in the human.

In an embodiment of any of the 21-25^(th) configurations, (i) theantibody or fragment comprises a VH domain derived from therecombination of a human VH segment, a human D gene segment and a humanJH segment, the human VH segment encoding the framework 1 of SEQ ID NO:40 and wherein said human comprises a VH gene segment encoding theframework 1 of SEQ ID NO: 40, or the human expresses VH domains thatcomprise the framework 1 of SEQ ID NO: 40; and wherein (ii) said humancomprises a nucleotide sequence encoding said IL4RA protein comprisingsaid mutation selected from the group consisting of I75V, E400A, C431R,S503P, Q576R and S752A in SEQ ID NO: 67.

Additionally or alternatively, in an embodiment of any of the 21-25^(th)configurations, (i) the antibody or fragment comprises a human gamma-4heavy chain constant region that comprises a Leu at position 189 shownin SEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73 andwherein said human comprises an IGHG4*01 human heavy chain constantregion gene segment, or the human expresses antibodies comprising humangamma-4 heavy chain constant regions comprising a Leu at position 189shown in SEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73;and wherein (ii) said human comprises a nucleotide sequence encodingsaid IL4RA protein comprising said mutation selected from the groupconsisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO:67.

In a Twenty-sixth Configuration, described herein is a method oftreating or reducing the risk of a Nav1.7-mediated disease or conditionin a human in need thereof, the method comprising administering to saidhuman a ligand (eg, an antibody or antibody fragment) that specificallybinds a human Nav1.7 protein that comprises an amino acid selected fromthe group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P,1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X(wherein X is an amino acid other than R), 328X (wherein X is an aminoacid other than Y), 395K, 459X (wherein X is an amino acid other thanS), 693 X (wherein X is an amino acid other than E), 767X (wherein X isan amino acid other than I), 830X (wherein X is an amino acid other thanR), 897X (wherein X is an amino acid other than W), 1200L, 1235L, 1488X(wherein X is an amino acid other than R), 1659X (wherein X is an aminoacid other than K), 1689X (wherein X is an amino acid other than W),422D, 490N, 943L, 1002L, 1161W and 1919G; wherein (i) the ligandcomprises a human gamma-4 heavy chain constant region that comprises aLeu at position 189 shown in SEQ ID NO: 73 or an Arg at position 289shown in SEQ ID NO: 73 and wherein said human comprises (i) an IGHG4*01human heavy chain constant region gene segment, or the human expressesantibodies comprising human gamma-4 heavy chain constant regionscomprising a Leu at position 189 shown in SEQ ID NO: 73 or an Arg atposition 289 shown in SEQ ID NO: 73; and wherein (ii) said humancomprises a nucleotide sequence encoding said Nav1.7 protein comprisingsaid amino acid selected from the group consisting of 136I, 216S, 241T,395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T,1462V, 1464I, 1627K, 277X (wherein X is an amino acid other than R),328X (wherein X is an amino acid other than Y), 395K, 459X (wherein X isan amino acid other than S), 693 X (wherein X is an amino acid otherthan E), 767X (wherein X is an amino acid other than I), 830X (wherein Xis an amino acid other than R), 897X (wherein X is an amino acid otherthan W), 1200L, 1235L, 1488X (wherein X is an amino acid other than R),1659X (wherein X is an amino acid other than K), 1689X (wherein X is anamino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G. Theinvention also provides a corresponding ligand, eg, antibody or antibodyfragment, for use in such a method.

In some embodiments, said amino acid is selected from the groupconsisting of any one of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863Pand 1449V; optionally wherein said disease or condition is a paindisease or condition. In some embodiments, said amino acid is selectedfrom the group consisting of 996C, 1298F, 1298D, 1299F, 1461T, 1462V,1464I and 1627K; optionally wherein said disease or condition is a paindisease or condition. In some embodiments, said amino acid is selectedfrom the group consisting of 277X (wherein X is an amino acid other thanR), 328X (wherein X is an amino acid other than Y), 395K, 459X (whereinX is an amino acid other than S), 693 X (wherein X is an amino acidother than E), 767X (wherein X is an amino acid other than I), 830X(wherein X is an amino acid other than R), 897X (wherein X is an aminoacid other than W), 1200L, 1235L, 1488X (wherein X is an amino acidother than R), 1659X (wherein X is an amino acid other than K) and 1689X(wherein X is an amino acid other than W); optionally wherein saiddisease or condition is a pain disease or condition.

In some embodiments, the constant region gene segment comprised by saidhuman is a germline gene segment. In some embodiments, the methodfurther comprises, before said administering, selecting a humancomprising said nucleotide sequence of (ii).

In some embodiments, the human has been determined to comprise thenucleotide sequence that encodes an Nav1.7 protein comprising said aminoacid selected from the group consisting of 136I, 216S, 241T, 395K, 848T,858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,1627K, 277X (wherein X is an amino acid other than R), 328X (wherein Xis an amino acid other than Y), 395K, 459X (wherein X is an amino acidother than S), 693 X (wherein X is an amino acid other than E), 767X(wherein X is an amino acid other than I), 830X (wherein X is an aminoacid other than R), 897X (wherein X is an amino acid other than W),1200L, 1235L, 1488X (wherein X is an amino acid other than R), 1659X(wherein X is an amino acid other than K), 1689X (wherein X is an aminoacid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G and/or anNav1.7 protein comprising said amino acid selected from the groupconsisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein Xis an amino acid other than R), 328X (wherein X is an amino acid otherthan Y), 395K, 459X (wherein X is an amino acid other than S), 693 X(wherein X is an amino acid other than E), 767X (wherein X is an aminoacid other than I), 830X (wherein X is an amino acid other than R), 897X(wherein X is an amino acid other than W), 1200L, 1235L, 1488X (whereinX is an amino acid other than R), 1659X (wherein X is an amino acidother than K), 1689X (wherein X is an amino acid other than W), 422D,490N, 943L, 1002L, 1161W and 1919G.

In some embodiments, the method further comprises the step ofdetermining that the human comprises (a) the nucleotide sequence thatencodes an Nav1.7 protein comprising said amino acid selected from thegroup consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P,1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X(wherein X is an amino acid other than R), 328X (wherein X is an aminoacid other than Y), 395K, 459X (wherein X is an amino acid other thanS), 693 X (wherein X is an amino acid other than E), 767X (wherein X isan amino acid other than I), 830X (wherein X is an amino acid other thanR), 897X (wherein X is an amino acid other than W), 1200L, 1235L, 1488X(wherein X is an amino acid other than R), 1659X (wherein X is an aminoacid other than K), 1689X (wherein X is an amino acid other than W),422D, 490N, 943L, 1002L, 1161W and 1919G and/or (b) an Nav1.7 proteincomprising said mutation said amino acid selected from the groupconsisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein Xis an amino acid other than R), 328X (wherein X is an amino acid otherthan Y), 395K, 459X (wherein X is an amino acid other than S), 693 X(wherein X is an amino acid other than E), 767X (wherein X is an aminoacid other than I), 830X (wherein X is an amino acid other than R), 897X(wherein X is an amino acid other than W), 1200L, 1235L, 1488X (whereinX is an amino acid other than R), 1659X (wherein X is an amino acidother than K), 1689X (wherein X is an amino acid other than W), 422D,490N, 943L, 1002L, 1161W and 1919G, optionally, wherein the determiningstep is performed before administration of the antibody to the human. Insome embodiments, the step of determining comprises assaying abiological sample from the human for a nucleotide sequence encoding aNav1.7 protein comprising said amino acid selected from the groupconsisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein Xis an amino acid other than R), 328X (wherein X is an amino acid otherthan Y), 395K, 459X (wherein X is an amino acid other than S), 693 X(wherein X is an amino acid other than E), 767X (wherein X is an aminoacid other than I), 830X (wherein X is an amino acid other than R), 897X(wherein X is an amino acid other than W), 1200L, 1235L, 1488X (whereinX is an amino acid other than R), 1659X (wherein X is an amino acidother than K), 1689X (wherein X is an amino acid other than W), 422D,490N, 943L, 1002L, 1161W and 1919G. In some embodiments, the assayingcomprises contacting the biological sample with at least oneoligonucleotide probe comprising a sequence of at least 10 contiguousnucleotides of a nucleotide sequence encoding an Nav1.7 proteincomprising said amino acid selected from the group consisting of 136I,216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D,1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acidother than R), 328X (wherein X is an amino acid other than Y), 395K,459X (wherein X is an amino acid other than S), 693 X (wherein X is anamino acid other than E), 767X (wherein X is an amino acid other thanI), 830X (wherein X is an amino acid other than R), 897X (wherein X isan amino acid other than W), 1200L, 1235L, 1488X (wherein X is an aminoacid other than R), 1659X (wherein X is an amino acid other than K),1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,1002L, 1161W and 1919G or comprising an antisense sequence of saidcontiguous nucleotides, wherein said sequence of contiguous nucleotidescomprises a nucleotide sequence encoding said amino acid selected fromthe group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P,1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X(wherein X is an amino acid other than R), 328X (wherein X is an aminoacid other than Y), 395K, 459X (wherein X is an amino acid other thanS), 693 X (wherein X is an amino acid other than E), 767X (wherein X isan amino acid other than I), 830X (wherein X is an amino acid other thanR), 897X (wherein X is an amino acid other than W), 1200L, 1235L, 1488X(wherein X is an amino acid other than R), 1659X (wherein X is an aminoacid other than K), 1689X (wherein X is an amino acid other than W),422D, 490N, 943L, 1002L, 1161W and 1919G, thereby forming a complex whenat least one nucleotide sequence encoding the Nav1.7 protein comprisingsaid amino acid selected from the group consisting of 136I, 216S, 241T,395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T,1462V, 1464I, 1627K, 277X (wherein X is an amino acid other than R),328X (wherein X is an amino acid other than Y), 395K, 459X (wherein X isan amino acid other than S), 693 X (wherein X is an amino acid otherthan E), 767X (wherein X is an amino acid other than I), 830X (wherein Xis an amino acid other than R), 897X (wherein X is an amino acid otherthan W), 1200L, 1235L, 1488X (wherein X is an amino acid other than R),1659X (wherein X is an amino acid other than K), 1689X (wherein X is anamino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G ispresent; and detecting the presence or absence of the complex, whereindetecting the presence of the complex determines that the humancomprises the Nav1.7 protein comprising said amino acid selected fromthe group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P,1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X(wherein X is an amino acid other than R), 328X (wherein X is an aminoacid other than Y), 395K, 459X (wherein X is an amino acid other thanS), 693 X (wherein X is an amino acid other than E), 767X (wherein X isan amino acid other than I), 830X (wherein X is an amino acid other thanR), 897X (wherein X is an amino acid other than W), 1200L, 1235L, 1488X(wherein X is an amino acid other than R), 1659X (wherein X is an aminoacid other than K), 1689X (wherein X is an amino acid other than W),422D, 490N, 943L, 1002L, 1161W and 1919G. In some embodiments, theassaying comprises nucleic acid amplification and optionally one or moremethods selected from sequencing, next generation sequencing, nucleicacid hybridization, and allele-specific amplification and/or wherein theassaying is performed in a multiplex format. In some embodiments, saidbiological sample comprises serum, blood, faeces, tissue, a cell, urineand/or saliva of said human.

In some embodiments, said human is indicated as heterozygous for anucleotide sequence encoding the Nav1.7 protein comprising said aminoacid selected from the group consisting of 136I, 216S, 241T, 395K, 848T,858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,1627K, 277X (wherein X is an amino acid other than R), 328X (wherein Xis an amino acid other than Y), 395K, 459X (wherein X is an amino acidother than S), 693 X (wherein X is an amino acid other than E), 767X(wherein X is an amino acid other than I), 830X (wherein X is an aminoacid other than R), 897X (wherein X is an amino acid other than W),1200L, 1235L, 1488X (wherein X is an amino acid other than R), 1659X(wherein X is an amino acid other than K), 1689X (wherein X is an aminoacid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G,optionally, wherein said human is further indicated as comprising thenucleotide sequence of SEQ ID NO: 76, or said human is indicated ashomozygous for a nucleotide sequence encoding the Nav1.7 proteincomprising said amino acid selected from the group consisting of 136I,216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D,1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acidother than R), 328X (wherein X is an amino acid other than Y), 395K,459X (wherein X is an amino acid other than S), 693 X (wherein X is anamino acid other than E), 767X (wherein X is an amino acid other thanI), 830X (wherein X is an amino acid other than R), 897X (wherein X isan amino acid other than W), 1200L, 1235L, 1488X (wherein X is an aminoacid other than R), 1659X (wherein X is an amino acid other than K),1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,1002L, 1161W and 1919G.

In some embodiments, said human is or has been further determined to besubstantially resistant to a pain or itching treatment. In someembodiments, said human is receiving or has received a pain oranti-itching treatment or has reduced responsiveness to a pain oritching treatment. In some embodiments, said disease or condition is apain or itching disease or condition. In some embodiments, said diseaseor condition is a channelopathy or associated with a channelopathy; oris selected from the group consisting of primary erythermalgia (PE),paroxysmal extreme pain disorder (PEPD) and channelopathy-associatedinsensitivity to pain (CIP). In some embodiments, said human has beendiagnosed with a pain or itching disease or condition.

In some embodiments, said ligand fragment treats or reduces the risk insaid human of a pain or itching disease or condition.

In some embodiments, the nucleotide sequence comprises one or more SNPsselected from the group consisting of rs6746030, rs3750904, rs58022607,rs4369876, rs13402180 and rs12478318.

In a Twenty-seventh Configuration, described herein is a method oftreating or reducing the risk of a disease or condition mediated byVEGF-A in a human, the method comprising administering to said human ananti-VEGF-A ligand (eg, an anti-VEGF-A trap, antibody or antibodyfragment) that specifically binds to a human VEGF-A that is expressed bya VEGF-A nucleotide sequence comprising a SNP selected from the groupconsisting of rs699947, rs833061, rs2010963, rs3025039, rs699946,rs2146323, rs1413711, rs833068, rs833069, rs3025000 and rs1570360,wherein said human comprises a VEGF-A nucleotide sequence comprisingsaid selected SNP. The invention also provides a corresponding ligand,eg, antibody or antibody fragment, for use in such a method.

In a Twenty-eighth Configuration, described herein is a method oftreating or reducing the risk of a disease or condition mediated byVEGF-A in a human, the method comprising administering to said human ananti-VEGF-A ligand (eg, an anti-VEGF-A trap, antibody or antibodyfragment) that specifically binds to a human VEGF-A, wherein the humancomprises (i) an ARMS2 nucleotide sequence comprising a G at theposition of SNP rs10490924; (ii) a CFH nucleotide sequence comprising aT at the position of SNP rs1061170 or an T at the position of rs3766404;or (iii) a VEGFR2 nucleotide sequence comprising SNP rs4576072 orrs6828477, wherein the ligand comprises a human gamma-1 heavy chainconstant region that comprises an amino acid selected from the groupconsisting of an Asp corresponding to position 204 of SEQ ID NO: 42 anda Leu corresponding to position 206 of SEQ ID NO: 42 and wherein saidhuman comprises an IGHG1*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-1heavy chain constant regions comprising said selected amino acid. TheseSNPs are associated with improved responses following anti-VEGF-Atreatment of an ocular disease or condition. The invention also providesa corresponding ligand, eg, antibody or antibody fragment, for use insuch a method.

In a Twenty-ninth Configuration, described herein is a method oftreating or reducing the risk of a VEGF-A mediated disease or conditionin a human, the method comprising administering an anti-human VEGF-Aligand to a human, wherein the human comprises (i) a PDGF-B nucleotidesequence comprising a SNP selected from the group consisting ofrs142404523 (ie, a C corresponding to position −776) and a C at theposition of rs1800818 (ie, a C corresponding to position −735); or (ii)a PDGFR-B nucleotide sequence comprising a SNP selected from the groupconsisting of rs246395 (ie, a G corresponding to position 2601) andrs74943037 (ie, a T corresponding to position 1391). The invention alsoprovides a corresponding ligand, eg, antibody or antibody fragment, foruse in such a method.

In an example of any of the 27-29th configurations, the ligand comprisesan antibody constant region (eg, an antibody Fc region). Optionally, theligand comprises a human gamma-1 heavy chain constant region thatcomprises an amino acid selected from the group consisting of an Aspcorresponding to position 204 of SEQ ID NO: 42 and a Leu correspondingto position 206 of SEQ ID NO: 42 and wherein said human comprises anIGHG1*01 human heavy chain constant region gene segment, or the humanexpresses antibodies comprising human gamma-1 heavy chain constantregions comprising said selected amino acid.

In an example of any of the 27-29th configurations the disease orcondition is an ocular condition or a cancer; or angiogenesis orneovascularisation.

In an example of any of the 27-29th configurations the method furthercomprises antagonising PDGF-B in said human.

In an example of any of the 27-29th configurations the method furthercomprises antagonising angiopoietin-2 (Ang2) in said human.

In a Thirtieth configuration, the invention provides:—

A method of treating or reducing the risk of a disease or conditionmediated by PD-L1 in a human, the method comprising administering tosaid human an anti-PD-L1 ligand (eg, an anti-PD-L1 trap, antibody orantibody fragment) that specifically binds to a human PD-L1 that isexpressed by a PD-L1 nucleotide sequence comprising a variation selectedfrom the variations listed in Table 21.

For example, there is provided a method of treating or reducing the riskof a disease or condition mediated by PD-L1 in a human, the methodcomprising administering to said human an anti-PD-L1 ligand (eg, ananti-PD-L1 trap, antibody or antibody fragment) that specifically bindsto a human PD-L1 that is expressed by a PD-L1 nucleotide sequencecomprising a variation selected from the variations listed in Table 21,wherein said human comprises a PD-L1 nucleotide sequence comprising saidselected variation.

For example, there is provided a method of treating or reducing the riskof a cancer in a human, the method comprising administering to saidhuman an anti-PD-L1 ligand (eg, an anti-PD-L1 trap, antibody or antibodyfragment) that specifically binds to a human PD-L1 that is expressed bya PD-L1 nucleotide sequence comprising a variation selected from thevariations listed in Table 21, wherein said human comprises a PD-L1nucleotide sequence comprising said selected variation.

For example, there is provided a method of treating or reducing the riskof an autoimmune disease or condition in a human, the method comprisingadministering to said human an anti-PD-L1 ligand (eg, an anti-PD-L1trap, antibody or antibody fragment) that specifically binds to a humanPD-L1 that is expressed by a PD-L1 nucleotide sequence comprising avariation selected from the variations listed in Table 21, wherein saidhuman comprises a PD-L1 nucleotide sequence comprising said selectedvariation.

For example, there is provided a method of treating or reducing the riskof an inflamatory disease or condition in a human, the method comprisingadministering to said human an anti-PD-L1 ligand (eg, an anti-PD-L1trap, antibody or antibody fragment) that specifically binds to a humanPD-L1 that is expressed by a PD-L1 nucleotide sequence comprising avariation selected from the variations listed in Table 21, wherein saidhuman comprises a PD-L1 nucleotide sequence comprising said selectedvariation.

In a Thirty-first configuration, the invention provides an anti-humanPD-L1 ligand (eg, an antibody, antibody fragment or human PD-L1 trap)for use in a method of the Thirtieth configuration.

Examples of any configuration or relating to any TOI are as follows:—

(i) wherein the ligand comprises a VH domain derived from therecombination of a human VH segment (eg, human VH3-23*04), a human Dgene segment and a human JH segment, the human VH segment encoding theframework 1 of SEQ ID NO: 40 and wherein said human comprises a VH genesegment encoding the framework 1 of SEQ ID NO: 40, or the humanexpresses VH domains that comprise the framework 1 of SEQ ID NO: 40.(ii) wherein the ligand comprises a VH domain derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment, and wherein said human comprises a IGHV3-7*01 VHgene segment or the human expresses VH domains derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment.(iii) wherein the ligand comprises a Vκ domain derived from therecombination of human Vκ segment IGKV1-12*01 and a human Jκ segment,and wherein said human comprises a IGKV1-12*01 Vκ gene segment or thehuman expresses Vκ domains derived from the recombination of human Vκsegment IGKV1-12*01 and a human Jκ segment.(iv) wherein the ligand comprises a Vκ domain derived from therecombination of a human Vκ segment and a human Jκ segment, the human Vκsegment encoding (i) a CDR3 comprising a Pro at position 7 shown in SEQID NO: 36 and wherein said human comprises a Vκ gene segment encoding aCDR3 comprising a Pro at position 7 shown in SEQ ID NO: 36, or the humanexpresses Vκ domains that comprise a CDR3 comprising a Pro at position 7shown in SEQ ID NO: 36; or (ii) a FW3 comprising a Ser at position 15shown in SEQ ID NO: 38 and wherein said human comprises a Vκ genesegment encoding a FW3 comprising a Ser at position 15 shown in SEQ IDNO: 38 or the human expresses Vκ domains that comprise a FW3 comprisinga Ser at position 15 shown in SEQ ID NO: 38.(v) wherein the ligand comprises a human gamma-1 heavy chain constantregion that comprises an Asp at position 204 shown in SEQ ID NO: 4 or aLeu at position 206 shown in SEQ ID NO: 4 and wherein said humancomprises (i) an IGHG1*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-1heavy chain constant regions comprising an Asp at position 204 shown inSEQ ID NO: 4 or a Leu at position 206 shown in SEQ ID NO: 4.(vi) wherein the ligand comprises a human gamma-2 heavy chain constantregion that comprises an amino acid selected from the group consistingof a Pro at position 72 shown in SEQ ID NO: 6, an Asn at position 75shown in SEQ ID NO: 6, a Phe at position 76 shown in SEQ ID NO: 6, a Valat position 161 shown in SEQ ID NO: 6 and an Ala at position 257 shownin SEQ ID NO: 6 and wherein said human comprises (i) an IGHG2*01 humanheavy chain constant region gene segment, or the human expressesantibodies comprising human gamma-2 heavy chain constant regionscomprising said selected Pro at position 72 shown in SEQ ID NO: 6, Asnat position 75 shown in SEQ ID NO: 6, Phe at position 76 shown in SEQ IDNO: 6, Val at position 161 shown in SEQ ID NO: 6 or Ala at position 257shown in SEQ ID NO: 6.(vii) wherein the ligand comprises a human kappa chain constant regionthat comprises a Val at position 84 shown in SEQ ID NO: 16 or a Cys atposition 87 shown in SEQ ID NO: 16 and wherein said human comprises (i)an IGKC1*01 human kappa chain constant region gene segment, or the humanexpresses antibodies comprising human kappa chain constant regionscomprising a Val corresponding to position 84 shown in SEQ ID NO: 16 ora Cys at position 87 shown in SEQ ID NO: 16.(viii) wherein the ligand comprises a human IGLC1*01 lambda chainconstant region and wherein said human comprises (i) a human IGLC1*01lambda chain constant region gene segment, or the human expressesantibodies comprising human IGLC1*01 lambda chain constant regions.(ix) wherein the ligand comprises a human gamma-4 heavy chain constantregion that comprises a Leu at position 189 shown in SEQ ID NO: 73 or anArg at position 289 shown in SEQ ID NO: 73 and wherein said humancomprises (i) an IGHG4*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-4heavy chain constant regions comprising a Leu at position 189 shown inSEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73.(x) wherein the ligand comprises a human gamma-3 heavy chain constantregion encoded by a first human IGHG3 (eg, IGHG3*01) constant regiongene segment and wherein said human comprises (i) said first constantregion gene segment (eg, an IGHG3*01), or the human expresses antibodiescomprising human gamma-3 heavy chain constant regions encoded by saidfirst human IGHG3 (eg, IGHG3*01) constant region gene segment.(xi) wherein the ligand comprises a human epsilon heavy chain constantregion encoded by a first human epsilon heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human epsilonheavy chain constant regions encoded by said first constant region genesegment.(xii) wherein the ligand comprises a human mu heavy chain constantregion encoded by a first human mu heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human muheavy chain constant regions encoded by said first constant region genesegment.(xiii) wherein the ligand comprises a human alpha heavy chain constantregion encoded by a first human alpha heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human alphaheavy chain constant regions encoded by said first constant region genesegment.(xiv) wherein the ligand comprises a human delta heavy chain constantregion encoded by a first human delta heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human deltaheavy chain constant regions encoded by said first constant region genesegment.(xv) wherein the ligand comprises a human kappa light chain constantregion encoded by a first human kappa light chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human kappalight chain constant regions encoded by said first constant region genesegment.(xvi) wherein the ligand comprises a human lambda light chain constantregion encoded by a first human lambda light chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human lambdalight chain constant regions encoded by said first constant region genesegment.

In some embodiments, said ligand (eg, antibody or antibody fragment) isadministered by inhaled, intravenous or subcutaneous administrationand/or is comprised in an inhalable or injectable preparation.

In some embodiments, the human gamma-4 heavy chain constant region ofthe ligand comprises the amino acid sequence of SEQ ID NO: 73 or an ADCCinactivated version thereof.

In some embodiments, the human gamma-4 heavy chain constant regioncomprises 228P and 235E.

Optionally in the present invention the TOI is selected from the groupconsisting of human TOIs: PCSK9, IL6R, IL4Ra, VEGF-A, Placental growthfactor (PGF), PDGF-B, PDGFR-B, Ang-2, Nav1.7, Nav1.8, Nav1.9, PD-1,PD-L1, ICOS, BMP6, hemojuvelin, ferroportin, TMPRSS6, transferrin, humanhemochromatosis protein (HFE) and sclerostin.

For example, the TOI is PCSK9.

For example, the TOI is IL6R.

For example, the TOI is IL4Ra.

For example, the TOI is VEGF-A.

For example, the TOI is Placental growth factor (PGF).

For example, the TOI is PDGF-B.

For example, the TOI is PDGFR-B.

For example, the TOI is Ang-2.

For example, the TOI is Nav1.7.

For example, the TOI is Nav1.8.

For example, the TOI is Nav1.9.

For example, the TOI is PD-1.

For example, the TOI is PD-L1.

For example, the TOI is ICOS.

For example, the TOI is BMP6.

For example, the TOI is hemojuvelin.

For example, the TOI is ferroportin.

For example, the TOI is TMPRSS6.

For example, the TOI is transferrin.

For example, the TOI is human hemochromatosis protein (HFE).

For example, the TOI is sclerostin.

BRIEF DESCRIPTION OF THE DRAWINGS

This patent or application file contains at least one drawing executedin color. Copies of this patent or patent application publication withcolor drawing(s) will be provided by the Office upon request and paymentof the necessary fee.

FIG. 1 shows in silico modeling of PCSK9 surface variant residues.

FIG. 2 depicts the cumulative allele frequency distribution across the1000 Genomes Project databse of human VH3-23 alleles comprising SNPrs56069819 (such alleles denonted “C” and the most frequent allele(which does not comprise this SNP) denoted “A”). The figure shows thatVH3-23 alleles comprising SNP rs56069819 are present at a cumulativefrequency of 11% across all human ethnic populations taken as a whole,whereas in certain specific human ethnic sub-populations (ASW, LWK, YRI,CEU and GBR) such alleles are present at an above-average cumulativefrequency. Indicated in the figure are those human PCSK9 variant forms(marked “Variants”) that are found in the various sub-populations withabove-average occurrence of human VH3-23 alleles comprising SNPrs56069819.

FIG. 3 depicts frameworks and CDRs encoded by VH3-23*04 as obtained fromthe IMGT database (available on the World Wide Web at www.IMGT.org).FIG. 3 discloses the nucleotide sequences as SEQ ID NOS 117, 117, 117,119, 119, 119, 120, 122, 124, 39 and 125, respectively, in order ofappearance. FIG. 3 discloses the coded amino acid sequences as SEQ IDNOS 118, 118, 118, 118, 118, 118, 121, 123, 123, 38 and 126,respectively, in order of appearance.

FIG. 4 depicts sequences of VH3-23*04. The portion of VH3-23*04comprising the FW1 residue change of rs56069819 (SEQ ID NO: 38). Theportion of the nucleic acid sequence encoding rs56069819 is depicted(SEQ ID NO: 39). The FW1 encoded by VH3-23*04 is depicted (SEQ ID NO:40).

DETAILED DESCRIPTION

The skilled person will know that SNPs or other changes that translateinto amino acid variation can cause variability in conformation oractivity of human targets to be addressed. This has spawned greatinterest in personalized medicine where genotyping and knowledge ofprotein and nucleotide variability is used to tailor medicines anddiagnosis of patients more effectively. The present invention providesfor tailored pharmaceuticals and testing that specifically addressesrarer variant forms of a human target of interest (TOI).

The present invention harnesses the power of human genetic variationanalysis and rationally-designed sequence selection. The technicalapplications of these approaches, as per the present invention,contribute to better treatment, prophylaxis and diagnosis in humans andprovides for patient benefit by providing choice and enablingpersonalized medicines and therapies. This provides advantages of betterprescribing, less wastage of medications and improved chances of drugefficacy and better diagnosis in patients.

As sources of genomic sequence variation data, the skilled person willbe aware of the available databases and resources (including updatesthereof) provided by the following:—

-   1. HapMap (The International HapMap Consortium. 2003; available on    the World Wide Web at hapmap.ncbi.nlm.nih.gov/index.html.en). The    HapMap Project is an international project that aims to compare the    genetic sequences of different individuals to identify chromosomal    regions containing shared genetic variants. The HapMap www site    provides tools to identify chromosomal regions and the variant    therein, with options to drill down to population level frequency    data.-   2. 1000 Genomes Project (The 1000 Genomes Project Consortium 2010;    available on the World

Wide Web at 1000 genomes.org/). This resource provides complete genomicsequence for at least 2500 unidentified individuals from one of 25distinct population groups.

-   3. Japanese SNP Database (H.Haga et al. 2002; available on the World    Wide Web at snp.ims.u-tokyo.ac.jp/index.html). Based on a study    identifying 190,562 human genetic variants.

The present invention involves the identification and cataloguing ofnaturally-occurring human genomic target sequence variants, includingthose found to be relatively low-frequency or rare variants thatsegregate with specific human ethnic populations and in many individualhumans.

An aspect of the invention is based on rational design of sequenceselection addressing the desirability to tailor medicaments anddiagnostics to rarer, but yet still significant groups of humanindividuals that suffer from, or have the potential to suffer from (ie,who are at risk of), a disease or condition mediated or associated withthe target of interest. In devising this rational design of the presentaspect of the invention, the inventor included considerations of thespread of prevalence of naturally-occurring target variant sequencesacross multiple, diverse human ethnic populations, as well as theimportance of addressing such populations where many individuals arelikely to display a genotype and/or phenotype of one or more of thevariants being analysed. As part of this design, the inventor saw theimportance of adopting the art-recognised classifications of humanethnic populations, and in this respect the inventor based the analysisand design on the recognised human ethnic populations adopted by the1000 Genomes Project, since this is a resource that is, and willcontinue to be, widely adopted by the scientific and medical community.

Thus, in this aspect of the invention, the inventor designed thefollowing variant sequence selection criteria, these being criteria thatthe inventor realised would provide for useful medical drugs anddiagnostics to tailored need in the human population.

Selection Criteria

Three or four of the following:—

-   -   Naturally-occurring human target variant sequences having a        cumulative human allele frequency of 35% or less;    -   Naturally-occurring human target variant sequences having a        total human genotype frequency of 40% or less;    -   Naturally-occurring human target variant sequences found in many        different human ethnic populations (using the standard        categorisation of the 1000 Genomes Project; see Table 4 below);        and    -   Naturally-occurring human target variant sequences found in many        individuals distributed across such many different ethnic        populations.

The inventor's selection included, as a consideration, selection fornucleotide variation that produced amino acid variation in correspondingTOI forms (ie, non-synonymous variations), as opposed to silentvariations that do not alter amino acid residues in the target protein.

In an embodiment, the cumulative human allele frequency is 30, 25, 20,15, 10 or 5% or less, eg, in the range from 1 to 20% or 1 to 15% or 1 to10%.

In an embodiment, the total human genotype frequency is 35, 30, 25, 20,15, 10 or 5% or less, eg, in the range from 1 to 25%, 1 to 20%, 1 to15%, 1 to about 15%, 1 to 10%, 1 to about 10% or 1 to 5% or 1 to about5%.

In an embodiment, the naturally-occurring human target variant sequencesare found in at least 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20different human ethnic populations (using the standard categorisation ofthe 1000 Genomes Project).

In an embodiment, the naturally-occurring human target variant sequencesare found in at least 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75,80, 85, 90, 95, 100, 105, 110, 115, 120, 130, 140 or 150 individualsdistributed across such many different ethnic populations.

In an example, the following criteria are applied:—

-   -   Naturally-occurring human target variant sequences having a        cumulative human allele frequency of 15% or less;    -   Naturally-occurring human target variant sequences having a        total human genotype frequency of 20% or less;    -   Naturally-occurring human target variant sequences found in at        least 5 different human ethnic populations (using the standard        categorisation of the 1000 Genomes Project); and    -   Naturally-occurring human target variant sequences found in many        individuals distributed across such many different ethnic        populations.

In an example, the criteria are applied with reference to one or morehuman genomic sequence databases as described herein. For example, thecriteria are those as applied to the 1000 Genomes database.

For example in any aspect example, embodiment or configuration of theinvention, the 1000 Genomes database release 13. For example, the 1000Genomes database in its most recent version as at 1 Oct. 2013.

Optionally, further sequence analysis and 3D in silico modelling (eg,see FIG. 1) can also be used as an additional selection criterion:variants whose variant amino acid residues (versus the most common formof human TOI) are surface-exposed on the target are desirable forselection, since the inventor saw these as contributing to determiningthe topography of the target and potentially contributing to how andwhere ligand binding on the target occurs.

The following bioinformatics protocol is envisaged to identify humansequences for use in the present invention:

-   -   (a) Identify a genomic region containing a target sequence of        interest (′target genomic region′) and calculate the genomic        coordinates, using coordinates that match the sequence assembly        build used by either the 1000 Genomes Project or International        HapMap project (or another selected human gene database of        choice).    -   (b) Identify genomic variants mapped to the genomic region        previously identified in (a). Retrieve allele frequencies for        variants for each super population and preferably sub-population        where such data is available. The VWC tools for the 1000 Genomes        Project can be used for this step.    -   (c) Filter list of genomic variants from target genomic region        to contain only variants classed as either ‘non-synonymous’        single nucleotide polymorphisms (SNPs) or genomic ‘insertions or        delections’ (indels). Filter further to include those that are        present in exonic sequences only. “Non-synonymous” refers to        nucleotide variation that produces amino acid variation (ie,        excluding silent mutations).    -   (d) Correlate population frequency data for each of the        identified variants for each of the super populations (for        example ‘European Ancestry’, ‘East Asian ancestry’, ‘West        African ancestry’, ‘Americas’, and ‘South Asian ancestry’) to        identify those variants that segregate with less than two        super-populations. Further correlate all identified variants        with each of the sub-populations (for example, ‘European        ancestry’ super-population might be subdivided into groups such        as ‘CEU—Utah residents with Northern or Western European        ancestry’, ‘TSI Toscani in Italia’ and ‘British from England and        Scotland’) and produce a second score for rarity of variants        within a super-population.    -   (e) Collect one or more sequences that show segregation to        specific sub-populations for use in the present invention, eg,        according to selection criteria as described herein.

Human Populations

Optionally the ethnic populations are selected from those identified inthe 1000 Genomes Project database. In this respect, see Table 4 whichprovides details of the ethnic populations on which the 1000 GenomesProject database is based.

N A Rosenberg et al (Science 20 Dec. 2002: vol. 298 no. 5602 2342-2343)studied the genetic structure of human populations of differinggeographical ancestry. In total, 52 populations were sampled, thesebeing populations with:

African Ancestry

(Mbuti Pygmies, Biaka Pygmies, San peoples, and speakers ofNiger-Kordofanian languages (Bantu, Yoruba or Mandenka populations),

Eurasian Ancestry

(European ancestry (Orcadian, Adygel, Basque, French, Russians,Italians, Sardinian, Tuscan),

Middle Eastern ancestry (Mozabite, Bedouin, Druze, Palestinians),

Central/South Asian ancestry (Balochl, Brahul, Makrani, Sindhi, Pathan,Burusho, Hazara, Uygur, Kalash)),

East Asian Ancestry

(Han, Dal, Daur, Hezhen, Lahu, Miao, Orogen, She, Tujia, Tu, Xibo, Yi,Mongola, Naxi, Cambodian, Japanese, Yakut), Oceanic ancestry(Melanesian, Papuan); or

Americas Ancestry

(Karitiana, Surui, Colombian, Maya, Pima).

The International HapMap Project, Nature, 2003 Dec. 18;426(6968):789-96, discloses that goal of the HapMap Project: todetermine the common patterns of DNA sequence variation in the humangenome by determining the genotypes of one million or more sequencevariants, their frequencies and the degree of association between themin DNA samples from populations with ancestry from parts of Africa, Asiaand Europe. The relevant human populations of differing geographicalancestry include Yoruba, Japanese, Chinese, Northern European andWestern European populations. More specifically:—

Utah population with Northern or Western European ancestry (samplescollected in 1980 by the Centre d′Etude du Polymorphisme Humain (CEPH));

population with ancestry of Yoruba people from Ibadan, Nigeria;

population with Japanese ancestry; and

population with ancestry of Han Chinese from China.

The authors, citing earlier publications, suggest that ancestralgeography is a reasonable basis for sampling human populations.

A suitable sample of human populations used in the present invention isas follows:—

-   -   (a) European ancestry    -   (b) Northern European ancestry; Western European ancestry;        Toscani ancestry; British ancestry, Finnish ancestry or Iberian        ancestry.    -   (c) More specifically, population of Utah residents with        Northern and/or Western European ancestry; Toscani population in        Italia; British population in England and/or Scotland; Finnish        population in Finland; or Iberian population in Spain.    -   (a) East Asian ancestry    -   (b) Japanese ancestry; Chinese ancestry or Vietnamese ancestry.    -   (c) More specifically, Japanese population in Toyko, Japan; Han        Chinese population in Beijing, China; Chinese Dai population in        Xishuangbanna; Kinh population in Ho Chi Minh City, Vietnam; or        Chinese population in Denver, Colo., USA.    -   (a) West African ancestry    -   (b) Yoruba ancestry; Luhya ancestry; Gambian ancestry; or        Malawian ancestry.    -   (c) More specifically, Yoruba population in Ibadan, Nigeria;        Luhya population in Webuye, Kenya; Gambian population in Western        Division, The Gambia; or Malawian population in Blantyre,        Malawi.    -   (a) Population of The Americas    -   (b) Native American ancestry; Afro-Caribbean ancestry; Mexican        ancestry; Puerto Rican ancestry; Columbian ancestry; or Peruvian        ancestry.    -   (c) More specifically, population of African Ancestry in        Southwest US; population of African

American in Jackson, Miss.; population of African Caribbean in Barbados;population of Mexican Ancestry in Los Angeles, Calif.; population ofPuerto Rican in Puerto Rico; population of Colombian in Medellin,Colombia; or population of Peruvian in Lima, Peru.

-   -   (a) South Asian ancestry    -   (b) Ahom ancestry; Kayadtha ancestry; Reddy ancestry; Maratha;        or Punjabi ancestry.    -   (c) More specifically, Ahom population in the State of Assam,        India; Kayadtha population in Calcutta, India; Reddy population        in Hyderabad, India; Maratha population in Bombay, India; or        Punjabi population in Lahore, Pakistan.

In any configuration of the invention, in one embodiment, each humanpopulation is selected from a population marked “(a)” above.

In any configuration of the invention, in another embodiment, each humanpopulation is selected from a population marked “(b)” above.

In any configuration of the invention, in another embodiment, each humanpopulation is selected from a population marked “(c)” above.

In one embodiment the ethnic populations are selected from the groupconsisting of an ethnic population with European ancestry, an ethnicpopulation with East Asian, an ethnic population with West Africanancestry, an ethnic population with Americas ancestry and an ethnicpopulation with South Asian ancestry.

In one embodiment the ethnic populations are selected from the groupconsisting of an ethnic population with Northern European ancestry; oran ethnic population with Western European ancestry; or an ethnicpopulation with Toscani ancestry; or an ethnic population with Britishancestry; or an ethnic population with Icelandic ancestry; or an ethnicpopulation with Finnish ancestry; or an ethnic population with Iberianancestry; or an ethnic population with Japanese ancestry; or an ethnicpopulation with Chinese ancestry; or an ethnic population Vietnameseancestry; or an ethnic population with Yoruba ancestry; or an ethnicpopulation with Luhya ancestry; or an ethnic population with Gambianancestry; or an ethnic population with Malawian ancestry; or an ethnicpopulation with Native American ancestry; or an ethnic population withAfro-Caribbean ancestry; or an ethnic population with Mexican ancestry;or an ethnic population with Puerto Rican ancestry; or an ethnicpopulation with Columbian ancestry; or an ethnic population withPeruvian ancestry; or an ethnic population with Ahom ancestry; or anethnic population with Kayadtha ancestry; or an ethnic population withReddy ancestry; or an ethnic population with Maratha; or an ethnicpopulation with Punjabi ancestry.

Anti-Target Ligands

The invention provides useful anti-target ligands for addressing humanssuffering from or likely to suffer from a disease or condition mediatedor associated with the TOI. For example, the ligand specifically bindsto the TOI variant as per the invention. The ligand may inhibit orantagonise the activity of the target, eg, the ligand neutralises thetarget. The skilled person will be familiar with neutralising ligands ingeneral, such as antibodies or antibody fragments, and can readily testsuitable ligands for specific binding and/or neutralisation of a targetin vitro or in an in vivo assay.

An antibody “fragment” comprises a portion of an intact antibody,preferably the antigen binding and/or the variable region of the intactantibody. Examples of antibody fragments include dAb, Fab, Fab′, F(ab′)2and Fv fragments; diabodies; linear antibodies; single-chain antibodymolecules and multispecific antibodies formed from antibody fragments.

In an embodiment, the ligand of the invention is or comprises anantibody or antibody fragment, for example an antibody or fragmentcomprising human variable regions (and optionally also human constantregions). Anti-TOI or TOI-binding or targeting antibodies and fragmentscan be prepared according to any known method, eg, using transgenic mice(eg, the Kymouse™ or Velocimouse™, or Omnimouse™, Xenomouse™, HuMabMouse™ or MeMo Mouse™), rats (eg, the Omnirat™), camelids, sharks,rabbits, chickens or other non-human animals immunised with the TOIfollowed optionally by humanisation of the constant regions and/orvariable regions to produce human or humanised antibodies. In anexample, display technologies can be used, such as yeast, phage orribosome display, as will be apparent to the skilled person. Standardaffinity maturation, eg, using a display technology, can be performed ina further step after isolation of an antibody lead from a transgenicanimal, phage display library or other library. Representative examplesof suitable technologies are described in US20120093818 (Amgen, Inc),which is incorporated herein by reference, eg, the methods set out inparagraphs [0309] to [0346]. Although this is with reference to PCSK9,the antibody-generating methods can be applied to other TOIs as per thebroadest scopes of the present invention.

Generally, a VELOCIMMUNE™ or other mouse or rat can be challenged withthe antigen of interest, and lymphatic cells (such as B-cells) arerecovered from the mice that express antibodies. The lymphatic cells maybe fused with a myeloma cell line to prepare immortal hybridoma celllines, and such hybridoma cell lines are screened and selected toidentify hybridoma cell lines that produce antibodies specific to theantigen of interest. DNA encoding the variable regions of the heavychain and light chain may be isolated and linked to desirable isotypicconstant regions of the heavy chain and light chain. Such an antibodyprotein may be produced in a cell, such as a CHO cell. Alternatively,DNA encoding the antigen-specific chimaeric antibodies or the variabledomains of the light and heavy chains may be isolated directly fromantigen-specific lymphocytes.

Initially, high affinity chimaeric antibodies are isolated having ahuman variable region and a mouse constant region. As described below,the antibodies are characterized and selected for desirablecharacteristics, including affinity, selectivity, epitope, etc. Themouse constant regions are replaced with a desired human constant regionto generate the fully human antibody of the invention, for examplewild-type or modified IgG1 or IgG4 (for example, SEQ ID NO: 751, 752,753in US2011/0065902, which sequences are incorporated herein by referencefor use in the ligands of the present invention). While the constantregion selected may vary according to specific use, high affinityantigen-binding and target specificity characteristics reside in thevariable region.

In an example, the ligand of the invention is or comprises a nucleicacid, eg, RNA, eg, siRNA that hybridises under stringent condition tothe TOI variant sequence, eg, hybridises a nucleotide sequencecomprising one or more nucleotides that are variant (versus the mostcommon TOI sequence, eg, with reference to the 1000 Genomes Projectdatabase).

Target binding ability, specificity and affinity (Kd, K_(off) and/orK_(on)) can be determined by any routine method in the art, eg, bysurface plasmon resonance (SPR). The term “Kd”, as used herein, isintended to refer to the equilibrium dissociation constant of aparticular antibody-antigen interaction.

In one embodiment, the surface plasmon resonance (SPR) is carried out at25° C. In another embodiment, the SPR is carried out at 37° C.

In one embodiment, the SPR is carried out at physiological pH, such asabout pH7 or at pH7.6 (eg, using Hepes buffered saline at pH7.6 (alsoreferred to as HBS-EP)).

In one embodiment, the SPR is carried out at a physiological salt level,eg, 150 mM NaCl.

In one embodiment, the SPR is carried out at a detergent level of nogreater than 0.05% by volume, eg, in the presence of P20 (polysorbate20; eg, Tween-20™) at 0.05% and EDTA at 3 mM.

In one example, the SPR is carried out at 25° C. or 37° C. in a bufferat pH7.6, 150 mM NaCl, 0.05% detergent (eg, P20) and 3 mM EDTA. Thebuffer can contain 10 mM Hepes. In one example, the SPR is carried outat 25° C. or 37° C. in HBS-EP. HBS-EP is available from Teknova Inc(California; catalogue number H8022).

In an example, the affinity of the ligand (eg, antibody) is determinedusing SPR by

-   1. Coupling anti-mouse (or other relevant human, rat or non-human    vertebrate antibody constant region species-matched) IgG (eg,    Biacore™ BR-1008-38) to a biosensor chip (eg, GLM chip) such as by    primary amine coupling;-   2. Exposing the anti-mouse IgG (or other matched species antibody)    to a test IgG antibody to capture test antibody on the chip;-   3. Passing the test antigen over the chip's capture surface at 1024    nM, 256 nM, 64 nM, 16 nM, 4 nM with a 0 nM (i.e. buffer alone); and-   4. And determining the affinity of binding of test antibody to test    antigen using surface plasmon resonance, eg, under an SPR condition    discussed above (eg, at 25° C. in physiological buffer). SPR can be    carried out using any standard SPR apparatus, such as by Biacore™ or    using the ProteOn XPR36™ (Bio-Rad®).

Regeneration of the capture surface can be carried out with 10 mMglycine at pH1.7. This removes the captured antibody and allows thesurface to be used for another interaction. The binding data can befitted to 1:1 model inherent using standard techniques, eg, using amodel inherent to the ProteOn XPR36™ analysis software.

In an example, the ligand of the invention is contained in a medicalcontainer, eg, a vial, syringe, IV container or an injection device (eg,an intraocular or intravitreal injection device). In an example, theligand is in vitro, eg, in a sterile container. In an example, theinvention provides a kit comprising the ligand of the invention,packaging and instructions for use in treating or preventing ordiagnosing in a human a disease or condition mediated by the TOI. In anexample, the instructions indicate that the human should be genotypedfor a TOI variant sequence of the invention before administering theligand to the human. In an example, the instructions indicate that thehuman should be phenotyped for a TOI variant of the invention beforeadministering the ligand to the human. In an example, the human is ofChinese (eg, Han) ethnicity and the instructions are in Chinese (eg,Mandarin). In an example, the instructions comprise directions toadminister alirocumab or evolocumab to said human.

The invention relates to the concepts set out in the following clauses.

Clause 1

A method of treating or preventing a disease or condition in a human,wherein the disease or condition is mediated by a Target of Interest(TOI), wherein the TOI is present in humans as different polymorphicvariants, the method comprising

-   -   a. Administering to the human an anti-TOI ligand to target a TOI        variant in the human and treat or prevent (eg, by at least 40,        50, 60, 70, 80, 90 or 95%) said disease or condition, wherein        the TOI in said human is encoded by a nucleotide sequence having        a cumulative human allele frequency of less than 50% and/or        wherein the TOI in said human is encoded by a nucleotide        sequence having a total human genotype frequency of less than        50%;        -   wherein        -   Before step (a) said human has been or is genotyped as            positive for said nucleotide sequence or phenotyped as            positive for said TOI variant, or the method comprises            before step (a) genotyping the human as positive for said            nucleotide sequence or phenotyping the human as positive for            said TOI variant.

In any aspect, configuration, example, embodiment, clause or conceptherein, frequencies may be determined using bioinformatics.

In any aspect, configuration, example, embodiment, clause or conceptherein, frequencies may be determined by reference to a databasecomprising at least 1000 or 2000 human sequences.

In any aspect, configuration, example, embodiment, clause or conceptherein “heterozygous human genotype frequency” means the cumulativefrequency of all genotypes in the sample or database or in humans havingone occurrence of the rare variant allele and one occurrence of anotherallele (heterozygous state), eg, genotype in 1000 Genomes database.

In any aspect, configuration, example, embodiment, clause or conceptherein “homozygous human genotype frequency means the cumulativefrequency of two occurrences of the variant allele (homozygous state),eg, genotype in 1000 Genomes Project database.

In any aspect, configuration, example, embodiment, clause or conceptherein “total human genotype frequency” means the total of heterozygousplus homozygous human genotype frequencies.

In any aspect, configuration, example, embodiment, clause or conceptherein “cumulative human allele frequency” refers to the total of alloccurrences of the variant allele (eg, SNP) in the sample or database orin humans, eg, in the 1000 Genomes Project database.

Clause 2:

The method of clause 1, wherein before step (a) the ligand has been oris determined as being capable of binding to said TOI variant, eg, withan affinity (Kd) disclosed below.

In an example, the ligand is (or has been determined as) a neutraliserof the TOI. In an example, determination is carried out in a human (eg,in a clinical trial). In an example, determination is carried out in anon-human, eg, in a mouse, rat, rabbit, pig, dog, sheep or non-humanprimate (eg, Cynomolgous monkey, rhesus monkey or baboon).

Clause 3:

A method of treating or preventing a disease or condition in a human,wherein the disease or condition is mediated by a Target of Interest(TOI), wherein the TOI is present in humans as different polymorphicvariants, the method comprising

-   -   a. Administering to the human an anti-TOI ligand to target a TOI        variant in the human and treat or prevent (eg, by at least 40,        50, 60, 70, 80, 90 or 95%) said disease or condition, wherein        the TOI in said human is encoded by a nucleotide sequence having        a cumulative human allele frequency of less than 50% and/or        wherein the TOI in said human is encoded by a nucleotide        sequence having a total human genotype frequency of less than        50%;        -   wherein    -   b. Before step (a) the ligand has been or is determined as        capable of binding to said TOI variant, eg, with an affinity        (Kd) disclosed below.

In an example, the ligand is (or has been determined as) a neutraliserof the TOI. In an example, determination is carried out in a human (eg,in a clinical trial). In an example, determination is carried out in anon-human, eg, in a mouse, rat, rabbit, pig, dog, sheep or non-humanprimate (eg, Cynomolgous monkey, rhesus monkey or baboon).

Clause 4:

The method of clause 3, wherein the genome of said human comprises anucleotide sequence encoding said TOI variant; and before step (a) saidnucleotide sequence has been or is determined as having a cumulativehuman allele frequency of less than 50% and/or having a total humangenotype frequency of less than 50%.

The TOI variant is not the most frequent.

Clause 5:

The method of clause 3 or 4, wherein said human has been or is genotypedas positive for said variant nucleotide sequence before step (a), or themethod comprises genotyping the human as positive for said variantnucleotide sequence before step (a).

Clause 6:

The method of any preceding clause, wherein the human has been or isphenotyped as positive for said TOI variant before step (a), or themethod comprises phenotyping the human as positive for said variantnucleotide sequence before step (a).

Clause 7:

The method of any preceding clause, wherein said frequency is less than10 or 15% (eg, from 1 to 10%).

In an embodiment, the cumulative human allele frequency is 30, 25, 20,15, 10 or 5% or less, eg, in the range from 1 to 20% or 1 to 15% or 1 to10%.

In an embodiment, the total human genotype frequency is 35, 30, 25, 20,15, 10 or 5% or less, eg, in the range from 1 to 25%, 1 to 20%, 1 to15%, 1 to about 15%, 1 to 10%, 1 to about 10% or 1 to 5% or 1 to about5%.

Clause 8:

The method of any preceding clause, wherein the ligand is capable ofbinding to two or more different TOI variants, each being encoded by anucleotide sequence having a cumulative human allele frequency of lessthan 50% (eg, from 1 to 10%) and/or having a total human genotypefrequency of less than 50% (eg, from 1 to 20%).

In an embodiment, the cumulative human allele frequency of each TOIvariant is 30, 25, 20, 15, 10 or 5% or less, eg, in the range from 1 to20% or 1 to 15% or 1 to 10%.

In an embodiment, the total human genotype frequency of each TOI variantis 35, 30, 25, 20, 15, 10 or 5% or less, eg, in the range from 1 to 25%,1 to 20%, 1 to 15%, 1 to about 15%, 1 to 10%, 1 to about 10% or 1 to 5%or 1 to about 5%.

Clause 9:

A method of treating or preventing a disease or condition in a human,wherein the disease or condition is mediated by a Target of Interest(TOI), wherein the TOI is present in humans as different polymorphicvariants, the method comprising

-   -   a. Administering to the human an anti-TOI ligand to target a TOI        variant in the human and treat or prevent (eg, by at least 40,        50, 60, 70, 80, 90 or 95%) said disease or condition, wherein        the TOI in said human is a variant encoded by a nucleotide        sequence having a cumulative human allele frequency of more than        50% (eg, the highest frequency) and/or having a total human        genotype frequency of more than 50% (eg, the highest frequency);        -   wherein    -   b. Before step (a) said human has been or is genotyped as        negative for a variant nucleotide sequence having a cumulative        human allele frequency of less than 50% and/or having a total        human genotype frequency of less than 50%; or phenotyped as        negative for a TOI variant encoded by a nucleotide sequence        having a cumulative human allele frequency of less than 50%        and/or having a total human genotype frequency of less than 50%;        -   or        -   Before step (a) said the method comprises genotyping the            human as negative for a variant nucleotide sequence having a            cumulative human allele frequency of less than 50% and/or            having a total human genotype frequency of less than 50%; or            phenotyping the human as negative for a TOI variant encoded            by a nucleotide sequence having a cumulative human allele            frequency of less than 50% and/or having        -   a total human genotype frequency of less than 50%.

In an embodiment, in (a) the cumulative human allele frequency is 55,60, 65, 70, 75, 80, 85 or 90 or more but less than 95, 96, 97, 98, 99 or100% (eg, in the range from 51 to 80%).

In an embodiment, in (a) the total human genotype frequency is 55, 60,65, 70, 75, 80, 85 or 90 or more but less than 95, 96, 97, 98, 99 or100% (eg, in the range from 51 to 80%).

In an embodiment, in (b) the cumulative human allele frequency is 30,25, 20, 15, 10 or 5% or less, eg, in the range from 1 to 20% or 1 to 15%or 1 to 10%.

In an embodiment, in (b) the total human genotype frequency is 35, 30,25, 20, 15, 10 or 5% or less, eg, in the range from 1 to 25%, 1 to 20%,1 to 15%, 1 to about 15%, 1 to 10%, 1 to about 10% or 1 to 5% or 1 toabout 5%.

Clause 10:

The method of clause 9, wherein before step (a), the human has been oris phenotyped as positive for the most frequent TOI variant or genotypedfor the nucleotide sequence thereof.

In an embodiment, before step (a) the human has been or is genotyped aspositive for TOI variant nucleotide sequence having a cumulative humanallele frequency of 55, 60, 65, 70, 75, 80, 85 or 90 or more but lessthan 95, 96, 97, 98, 99 or 100% (eg, in the range from 51 to 80%) orphenotyped for the TOI variant thereof.

In an embodiment, before step (a) the human has been or is genotyped aspositive for TOI variant nucleotide sequence having a total humangenotype frequency of 55, 60, 65, 70, 75, 80, 85 or 90 or more but lessthan 95, 96, 97, 98, 99 or 100% (eg, in the range from 51 to 80%) orphenotyped for the TOI variant thereof.

Clause 11:

The method of clause 9 or 10, wherein before step (a) the ligand hasbeen or is determined as being capable of binding to the most frequentTOI variant.

Clause 12:

The method of clause 9, 10 or 11, wherein before step (a) the ligand hasbeen or is determined as being substantially incapable of neutralisingor inhibiting said TOI variant recited in step (b).

By “substantially incapable or neutralising or inhibiting” is meant:Neutralisation or inhibition less than 50, 25, 10, 5 or 0.5% inhibitionor neutralisation of the most frequent TOI variant.

Clause 13:

The method of any one of clauses 9 to 12, wherein the ligand is capableof binding to the most frequent TOI variant.

Clause 14:

The method of any one of clauses 9 to 13, wherein the ligand is capableof binding to two or more different TOI variants, each being encoded bya nucleotide sequence having a cumulative human allele frequency of morethan 50%.

In an embodiment, each TOI variant is encoded by a nucleotide sequencehaving a cumulative human allele frequency of 55, 60, 65, 70, 75, 80, 85or 90 or more but less than 95, 96, 97, 98, 99 or 100% (eg, in the rangefrom 51 to 80%).

In an embodiment, each TOI variant is encoded by a nucleotide sequencehaving a total human genotype frequency of 55, 60, 65, 70, 75, 80, 85 or90 or more but less than 95, 96, 97, 98, 99 or 100% (eg, in the rangefrom 51 to 80%).

Clause 15:

The method of any preceding clause, wherein said variant nucleotidesequence recited in step (a) has been or is determined as being presentin at least 2 different human ethnic populations, eg, at least 2, 3, 4,5, 6, 7, 8 or 9 different human ethnic populations in Table 4.

Clause 16:

The method of any preceding clause, wherein said human frequency is thefrequency in a database of naturally-occurring sequences sampled from atleast 15, 20 or 25 different human ethnic populations and comprising atleast 1000 sequences. In an embodiment, the database is the 1000 GenomesProject database as described herein.

Clause 17:

An anti-human TOI ligand for use in a method of treating and/orpreventing a TOI-mediated disease or condition in a human, wherein theTOI is present in humans as different polymorphic variants and whereinthe genome of said human comprises a TOI nucleotide sequence having acumulative human allele frequency of less than 50% and/or a total humangenotype frequency of less than 50%, the method comprising administeringthe ligand to the human.

In the alternative, clause 17 provides an anti-human TOI ligand for usein a method according to any one of clauses 1 to 16, the methodcomprising administering the ligand to the human.

In an embodiment, the cumulative human allele frequency is 30, 25, 20,15, 10 or 5% or less, eg, in the range from 1 to 20% or 1 to 15% or 1 to10%.

In an embodiment, the total human genotype frequency is 35, 30, 25, 20,15, 10 or 5% or less, eg, in the range from 1 to 25%, 1 to 20%, 1 to15%, 1 to about 15%, 1 to 10%, 1 to about 10% or 1 to 5% or 1 to about5%.

Clause 18:

The ligand of clause 17, wherein the ligand has been or is determined ascapable of binding the human TOI encoded by said nucleotide sequence.

In the alternative, clause 18 provides a ligand that binds a human TOIcomprising an amino acid sequence encoded by a TOI nucleotide sequencehaving a cumulative human allele frequency of less than 50% and/or atotal human genotype frequency of less than 50%, for use in a methodcomprising the step of using the ligand to target said TOI in a human totreat and/or prevent a disease or condition mediated by TOI, the methodcomprising administering the ligand to the human.

Clause 19:

A ligand that binds a human TOI comprising an amino acid sequenceencoded by a TOI nucleotide sequence having a cumulative human allelefrequency of less than 50% and/or a total human genotype frequency ofless than 50%, for use in a method according to any one of clauses 1 to16, the method comprising administering the ligand to the human.

Clause 20:

The ligand of any one of clauses 17 to 19, wherein the human has been oris genotyped as positive for said TOI nucleotide sequence having acumulative human allele frequency of less than 50%.

The ligand of any one of clauses 17 to 19, wherein the human has been oris genotyped as positive for said TOI nucleotide sequence having a totalhuman genotype frequency of less than 50%.

Clause 21:

The ligand of any one of clauses 17 to 20, wherein the human has been oris phenotyped as positive for a TOI encoded by a nucleotide sequencehaving a cumulative human allele frequency of less than 50% and/orhaving a total human genotype frequency of less than 50%.

Clause 22:

The ligand of any one of clauses 17 to 21, wherein the human has been oris genotyped as heterozygous for a TOI nucleotide sequence having acumulative human allele frequency of less than 50% and/or having a totalhuman genotype frequency of less than 50%; optionally wherein the humanhas been or is genotyped as comprising a TOI nucleotide sequence havinga cumulative human allele frequency of less than 50% and a TOInucleotide sequence having a cumulative human allele frequency of morethan 50% (eg, having the highest cumulative human allele frequency)and/or having a total human genotype frequency of more than 50% (eg,having the highest total human genotype frequency).

Clause 23:

The ligand of any one of clauses 17 to 22, wherein the genome of thehuman has been or is genotyped as homozygous for a TOI nucleotidesequence having a cumulative human allele frequency of less than 50%and/or having a total human genotype frequency of less than 50%.

Clause 24:

The ligand of any one of clauses 17 to 23, wherein the ligand comprisesan antibody binding site that binds a human TOI comprising an amino acidsequence encoded by a TOI nucleotide sequence having a cumulative humanallele frequency of less than 50% and/or having a total human genotypefrequency of less than 50%; and optionally has been or is determined ascapable of such binding.

Clause 25:

The ligand of clause 24, wherein the ligand is an antibody or antibodyfragment.

Clause 26:

The ligand of any one of clauses 17 to 23, wherein the ligand comprisesa nucleotide sequence that specifically hybridises to a TOI nucleotidesequence having a cumulative human allele frequency of less than 50%and/or having a total human genotype frequency of less than 50% or anRNA transcript thereof; and/or the ligand comprises a nucleotidesequence that comprises at least 10 contiguous nucleotides of anucleotide sequence having a cumulative human allele frequency of lessthan 50% and/or having a total human genotype frequency of less than 50%or is an antisense sequence thereof.

In an embodiment, the ligand comprises a nucleotide sequence thatcomprises at least 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50 or100 contiguous nucleotides of a nucleotide sequence having a cumulativehuman allele frequency of less than 50% and/or having a total humangenotype frequency of less than 50% or is an antisense sequence thereof.

Clause 27:

The ligand of any one of clauses 17 to 26, wherein the genome of saidhuman comprises a nucleotide sequence having a cumulative human allelefrequency of less than 50% and the sequence is found in at least 2different ethnic populations (eg, found in at least 9, 10, 11, 12, 13,14, 15, 16, 17, 18, 19 or 20 different human ethnic populations (forexample as per the populations in Table 4)). In an example, numbers arewith reference to the 1000 Genomes Project database.

The ligand of any one of clauses 17 to 26, wherein the genome of saidhuman comprises a nucleotide sequence having a cumulative human allelefrequency of less than 50% and the sequence is found in at least 20individuals distributed across at least 2 said different ethnicpopulations (eg, found in at least in at least 20, 25, 30, 35, 40, 45,50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 130,140 or 150 individuals distributed across such many different ethnicpopulations). In an example, numbers are with reference to the 1000Genomes Project database.

Clause 28:

A pharmaceutical composition or kit for treating or preventing acondition or disease mediated by a TOI as recited in any precedingclause, the composition or kit comprising a ligand of any one of clauses17 to 27; and optionally in combination with a label or instructions foruse to treat and/or prevent said disease or condition in a human;optionally wherein the label or instructions comprise a marketingauthorisation number (eg, an FDA or EMA authorisation number);optionally wherein the kit comprises an injection pen or IV containerthat comprises the ligand.

In an example, the label or instructions cover or describe use for ahuman comprising a TOI variant encoded by a nucleotide sequence asrecited in clause 17.

Clause 29:

A method of producing an anti-human TOI antibody binding site, themethod comprising obtaining a plurality of anti-TOI antibody bindingsites, screening the antibody binding sites for binding to a TOIcomprising an amino acid sequence encoded by a nucleotide sequencehaving a cumulative human allele frequency of less than 50% and/or atotal human genotype frequency of less than 50%, or to a peptide thereofthat comprises an amino acid variation from the corresponding sequenceencoded by the TOI-encoding nucleotide sequence having the highestcumulative human allele frequency and/or the highest total humangenotype frequency, and isolating an antibody binding site that binds inthe screening step.

In an embodiment of any aspect herein, the antibody, fragment or bindingsite is recombinant

In the alternative, clause 29 provides: A method of producing ananti-human TOI antibody, the method comprising immunising a non-humanvertebrate (eg, a mouse or a rat) with a TOI comprising an amino acidsequence encoded by a nucleotide sequence having a cumulative humanallele frequency of less than 50% and/or a total human genotypefrequency of less than 50%, or to a peptide thereof that comprises anamino acid variation from the corresponding sequence encoded by theTOI-encoding nucleotide sequence having the highest cumulative humanallele frequency and/or the highest total human genotype frequency, andisolating an antibody that binds a TOI comprising an amino acid sequenceencoded by a TOI nucleotide sequence having a cumulative human allelefrequency of less than 50% and/or a total human genotype frequency ofless than 50%, and optionally producing a TOI-binding fragment orderivative of the isolated antibody.

The term “isolated” with reference to a ligand, antibody or protein, forexample in any aspect, configuration, example or embodiment, means thata subject ligand, antibody, protein etc (1) is free of at least someother proteins with which it would normally be found, (2) is essentiallyfree of other proteins from the same source, e.g., from the samespecies, (3) is expressed by a cell from a different species, (4) hasbeen separated from at least about 50 percent of polynucleotides,lipids, carbohydrates, or other materials with which it is associated innature, (5) is operably associated (by covalent or noncovalentinteraction) with a polypeptide with which it is not associated innature, or (6) does not occur in nature. Typically, an “isolated”ligand, antibody, protein etc constitutes at least about 5%, at leastabout 10%, at least about 25%, or at least about 50% of a given sample.Genomic DNA, cDNA, mRNA or other RNA, of synthetic origin, or anycombination thereof can encode such an isolated ligand, antibody proteinetc. Preferably, the isolated ligand, antibody protein etc issubstantially free from proteins or polypeptides or other contaminantsthat are found in its natural environment that would interfere with itstherapeutic, diagnostic, prophylactic, research or other use.

For example, an “isolated” antibody is one that has been identified,separated and/or recovered from a component of its productionenvironment (eg, naturally or recombinantly). Preferably, the isolatedpolypeptide is free of association with all other components from itsproduction environment, eg, so that the antibody has been isolated to anFDA-approvable or approved standard. Contaminant components of itsproduction environment, such as that resulting from recombinanttransfected cells, are materials that would typically interfere withresearch, diagnostic or therapeutic uses for the antibody, and mayinclude enzymes, hormones, and other proteinaceous or non-proteinaceoussolutes. In preferred embodiments, the polypeptide will be purified: (1)to greater than 95% by weight of antibody as determined by, for example,the Lowry method, and in some embodiments, to greater than 99% byweight; (2) to a degree sufficient to obtain at least 15 residues ofN-terminal or internal amino acid sequence by use of a spinning cupsequenator, or (3) to homogeneity by SDS-PAGE under non-reducing orreducing conditions using Coomassie blue or, preferably, silver stain.Isolated antibody includes the antibody in situ within recombinant cellssince at least one component of the antibody's natural environment willnot be present. Ordinarily, however, an isolated polypeptide or antibodywill be prepared by at least one purification step.

Immunoconjugates

The invention encompasses the ligand (eg, antibody) conjugated to atherapeutic moiety (“immunoconjugate”), such as a cytotoxin, achemotherapeutic drug, an immunosuppressant or a radioisotope. Cytotoxinagents include any agent that is detrimental to cells. Examples ofsuitable cytotoxin agents and chemotherapeutic agents for formingimmunoconjugates are known in the art, see for example, WO 05/103081.

Bispecifics

The antibodies of the present invention may be monospecific, bispecific,or multispecific. Multispecific mAbs may be specific for differentepitopes of one target polypeptide or may contain antigen-bindingdomains specific for more than one target polypeptide. See, e.g., Tuttet al. (1991) J. Immunol 147:60-69. The human anti-TOI (eg, anti-PCSK9)mAbs can be linked to or co-expressed with another functional molecule,e.g., another peptide or protein. For example, an antibody or fragmentthereof can be functionally linked (e.g., by chemical coupling, geneticfusion, noncovalent association or otherwise) to one or more othermolecular entities, such as another antibody or antibody fragment, toproduce a bispecific or a multispecific antibody with a second bindingspecificity.

An exemplary bi-specific antibody format that can be used in the contextof the present invention involves the use of a first immunoglobulin (Ig)CH3 domain and a second Ig CH3 domain, wherein the first and second IgCH3 domains differ from one another by at least one amino acid, andwherein at least one amino acid difference reduces binding of thebispecific antibody to Protein A as compared to a bi-specific antibodylacking the amino acid difference. In one embodiment, the first Ig CH3domain binds Protein A and the second Ig CH3 domain contains a mutationthat reduces or abolishes Protein A binding such as an H95R modification(by IMGT exon numbering; H435R by EU numbering). The second CH3 mayfurther comprise a Y96F modification (by IMGT; Y436F by EU). Furthermodifications that may be found within the second CH3 include: D16E,L18M, N44S, K52N, V57M, and V821 (by IMGT; D356E, L358M, N384S, K392N,V397M, and V422I by EU) in the case of IgG1 antibodies; N44S, K52N, andV82I (IMGT; N384S, K392N, and V422I by EU) in the case of IgG2antibodies; and Q15R, N44S, K52N, V57M, R69K, E79Q, and V82I (by IMGT;Q355R, N3845, K392N, V397M, R409K, E419Q, and V422I by EU) in the caseof IgG4 antibodies. Variations on the bi-specific antibody formatdescribed above are contemplated within the scope of the presentinvention.

Clause 30:

The method of clause 29, comprising the step of obtaining a nucleic acidencoding the antibody, fragment, derivative or binding site andoptionally inserting the nucleic acid in an expression vector.

Clause 31:

A kit for TOI genotyping a human, wherein the kit comprises a nucleicacid comprising a nucleotide sequence that specifically hybridises to aTOI nucleotide sequence selected having a cumulative human allelefrequency of less than 50% and/or a total human genotype frequency ofless than 50% or an RNA transcript thereof; and/or the nucleic acidcomprises a nucleotide sequence that comprises at least 10 (eg, at least10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50 or 100) contiguousnucleotides of a TOI nucleotide sequence having a cumulative humanallele frequency of less than 50% and/or a total human genotypefrequency of less than 50% or is an antisense sequence thereof.

For example, the nucleic acid hybridises to a region immediatelyflanking a nucleotide that is variant compared to the correspondingnucleotide of the TOI nucleotide sequence having the highest cumulativehuman allele frequency and/or the highest total human genotypefrequency. In an example, the nucleic acid hybridises to at two or moresuch variant nucleotides.

Specific hybridisation is under stringent conditions, as will beapparent to the skilled person, eg, conditions of 5×SSC, 5×Denhardt'sreagent, and 0.5% SDS at 65° C.

Clause 32:

A kit for TOI genotyping or phenotyping a human, wherein the kitcomprises a ligand according to any one of clauses 17 to 27 or anantibody, fragment or derivative produced by the method of any one ofclauses 29 to 31.

For example, the ligand specifically binds to an epitope comprising anamino acid that is variant compared to the corresponding amino acid ofthe TOI encoded by a nucleotide sequence having the highest cumulativehuman allele frequency and/or the highest total human genotypefrequency. In an example, the ligand specifically binds to an epitopecomprising two or more such variant amino acids. In an example, specificbinding means binding with an affinity (Kd) of 1 mM, 100 nM, 10 nM or 1nM or less, eg, as determined by SPR.

The term “epitope” is a region of an antigen that is bound by anantibody. Epitopes may be defined as structural or functional.Functional epitopes are generally a subset of the structural epitopesand have those residues that directly contribute to the affinity of theinteraction. Epitopes may also be conformational, that is, composed ofnon-linear amino acids. In certain embodiments, epitopes may includedeterminants that are chemically active surface groupings of moleculessuch as amino acids, sugar side chains, phosphoryl groups, or sulfonylgroups, and, in certain embodiments, may have specific three-dimensionalstructural characteristics, and/or specific charge characteristics.

Clause 33:

Use of an anti-TOI ligand that binds a human TOI comprising an aminoacid sequence encoded by a TOI nucleotide sequence having a cumulativehuman allele frequency of less than 50% and/or a total human genotypefrequency of less than 50%, in the manufacture of a medicament fortreating and/or preventing a TOI-mediated disease or condition in ahuman whose genome comprises a TOI nucleotide sequence having acumulative human allele frequency of less than 50% and/or having a totalhuman genotype frequency of less than 50%.

Clause 34:

Use of an anti-TOI ligand that binds a human TOI comprising an aminoacid sequence encoded by a TOI nucleotide sequence having a cumulativehuman allele frequency of less than 50% and/or a total human genotypefrequency of less than 50%, in the manufacture of a medicament fortargeting said TOI in a human to treat and/or prevent a disease orcondition mediated by TOI.

The use of clause 33 or 34, wherein the ligand, human, disease orcondition is according to any one of clauses 1 to 27.

Clause 35:

A method of targeting a TOI for treating and/or preventing aTOI-mediated disease or condition in a human, the method comprisingadministering an anti-TOI ligand to a human comprising a TOI nucleotidesequence selected having a cumulative human allele frequency of lessthan 50% and/or a total human genotype frequency of less than 50%,whereby a TOI encoded by said nucleotide sequence is targeted.

Clause 36:

The method of clause 35, wherein the method comprises targeting a humanTOI comprising an amino acid sequence with said ligand to treat and/orprevent said disease or condition in said human, wherein said amino acidsequence is encoded by a nucleotide sequence having a cumulative humanallele frequency of less than 50% and/or a total human genotypefrequency of less than 50%.

Clause 37:

A method of TOI genotyping a nucleic acid sample of a human, the methodcomprising identifying in the sample the presence of a TOI nucleotidesequence having a cumulative human allele frequency of less than 50%and/or having a total human genotype frequency of less than 50%.

In an example, the method comprises obtaining a TOI nucleic acid samplefrom the human and then carrying out the identifying step.

Clause 38:

A method of TOI typing a protein sample of a human, the methodcomprising identifying in the sample the presence of a TOI amino acidsequence encoded by a TOI nucleotide sequence having a cumulative humanallele frequency of less than 50% and/or having a total human genotypefrequency of less than 50%.

In an example, the method comprises obtaining a TOI protein sample fromthe human and then carrying out the identifying step.

Clause 39:

The method of clause 37 or 38, comprising obtaining a sample of serum,blood, faeces, hair, urine or saliva from a human, whereby the nucleicacid or protein sample is obtained for use in the step of identifyingsaid sequence.

Clause 40:

The method of any one of clauses 37 to 39, comprising using a ligandaccording to any one of clauses 17 to 27 to carry out said identifyingstep.

Clause 41:

A diagnostic kit comprising a ligand that is capable of binding a humanTOI comprising an amino acid sequence encoded by a TOI nucleotidesequence having a cumulative human allele frequency of less than 50%and/or a total human genotype frequency of less than 50% andinstructions for carrying out the method of clause 38 or 39.

Clause 42:

A diagnostic kit comprising a nucleic acid probe comprising a nucleotidesequence that specifically hybridises a TOI nucleotide sequence having acumulative human allele frequency of less than 50% and/or a total humangenotype frequency of less than 50% or an RNA transcript thereof andinstructions for carrying out the method of clause 38 or 39.

Clause 43:

The method, ligand, composition, kit or use of any preceding clause,wherein the TOI is encoded by a nucleotide sequence having a cumulativehuman allele frequency from 1 to 10% and/or a total human genotypefrequency from 1 to about 15% or from 1 to 15%.

Clause 44:

The method, ligand, composition, kit or use of any preceding clausewherein the TOI is a human TOI selected from Table 5; optionally fortreating and/or preventing a corresponding disease or condition as setout in Table 5.

For example, the TOI is human PCSK9, eg, a mature, cleaved,autocatalysed or active PCSK9. In an example, the disease is acardiovascular disease such as hyperlipidaemia.

Ligands of the invention are useful, for instance, in specific bindingassays, for genotyping or phenotyping humans, affinity purification ofthe TOI and in screening assays to identify other antagonists of TOIactivity. Some of the ligands of the invention are useful for inhibitingbinding of TOI to a congnate human receptor or protein, or inhibitingTOI-mediated activities.

The invention encompasses anti-TOI (eg, PCSK9) antibody ligands having amodified glycosylation pattern. In some applications, modification toremove undesirable glycosylation sites may be useful, or e.g., removalof a fucose moiety to increase antibody dependent cellular cytotoxicity(ADCC) function (see Shield et al. (2002) JBC 277:26733). In otherapplications, modification of galactosylation can be made in order tomodify complement dependent cytotoxicity (CDC).

In an example, the invention features a pharmaceutical compositioncomprising a ligand of the invention, wherein the ligand is or comprisesa recombinant human antibody or fragment thereof which specificallybinds the TOI (eg, a rare variant as described herein) and apharmaceutically acceptable carrier. In one embodiment, the inventionfeatures a composition which is a combination of an antibody ligand orantigen-binding fragment of an antibody of the invention, and a secondtherapeutic agent. The second therapeutic agent may be any of ananti-inflammatory agent, an anti-angiogenesis agent, a painkiller, adiuretic, a chemotherapeutic agent, an anti-neoplastic agent, avasodilator, a vasoconstrictor, a statin, a beta blocker, a nutrient, anadjuvant, an anti-obesity agent and an anti-diabetes agent.

“Pharmaceutically acceptable” refers to approved or approvable by aregulatory agency of the USA Federal or a state government or listed inthe U.S. Pharmacopeia or other generally recognized pharmacopeia for usein animals, including humans. A “pharmaceutically acceptable carrier,excipient, or adjuvant” refers to an carrier, excipient, or adjuvantthat can be administered to a subject, together with an agent, e.g., anyantibody or antibody chain described herein, and which does not destroythe pharmacological activity thereof and is nontoxic when administeredin doses sufficient to deliver a therapeutic amount of the agent.

In an example, the invention features a method for inhibiting TOIactivity using the anti-TOI ligand of the invention (eg, an antibody orantigen-binding portion of the antibody of the invention), wherein thetherapeutic method comprises administering a therapeutically effectiveamount of a pharmaceutical composition comprising the ligand. Thedisorder treated is any disease or condition which is improved,ameliorated, inhibited or prevented by removal, inhibition or reductionof TOI activity.

By the phrase “therapeutically effective amount” is meant an amount thatproduces the desired effect for which it is administered. The exactamount will depend on the purpose of the treatment, and will beascertainable by one skilled in the art using known techniques (see, forexample, Lloyd (1999) The Art, Science and Technology of PharmaceuticalCompounding).

The term “specifically binds,” or the like, means that a ligand, eg, anantibody or antigen-binding fragment thereof, forms a complex with anantigen that is relatively stable under physiologic conditions. Specificbinding can be characterized by an equilibrium dissociation constant ofat least about 1×10⁻⁶M or less (e.g., a smaller KD denotes a tighterbinding). Methods for determining whether two molecules specificallybind are well known in the art and include, for example, equilibriumdialysis, surface plasmon resonance, and the like. An isolated antibodythat specifically binds a human TOI may, however, exhibitcross-reactivity to other antigens such as a TOI molecule from anotherspecies. Moreover, multi-specific antibodies (e.g., bispecifics) thatbind to human TOI and one or more additional antigens are nonethelessconsidered antibodies that “specifically bind” TOI, as used herein.

Genotyping & Phenotyping

The skilled person will be familiar with techniques that can be used foraccurate genotyping and application to the invention. These include thefollowing.

1 Hybridization-based methods

1.1 Dynamic allele-specific hybridization

1.2 Molecular beacons

1.3 SNP microarrays

2 Enzyme-based methods

2.1 Restriction fragment length polymorphism

2.2 PCR-based methods

2.3 Flap endonuclease

2.4 Primer extension

2.5 5′-nuclease

2.6 Oligonucleotide Ligation Assay

3 Other post-amplification methods based on physical properties of DNA

3.1 Single strand conformation polymorphism

3.2 Temperature gradient gel electrophoresis

3.3 Denaturing high performance liquid chromatography

3.4 High-resolution melting of the entire amplicon

3.5 Use of DNA mismatch-binding proteins

3.6 SNPlex (SNPlex™ is a proprietary genotyping platform sold by AppliedBiosystems).

Next-generation sequencing technologies such as pyrosequencing is alsouseful.

Reference is also made to GB2444410A and the genotyping method disclosedtherein, which is incorporated herein by reference in its entirety.

Miniaturized assays, such as microarrays with oligonucleotide reagentsimmobilized on small surfaces, are frequently proposed for large-scalemutation analysis and high-throughput genotyping (Large-scaleidentification, mapping, and genotyping of single-nucleotidepolymorphisms in the human genome (Wang D G, Fan J B, Siao C J, Berno A,Young P, Sapolsky R, Ghandour G, Perkins N, Winchester E, Spencer J,Kruglyak L, Stein L, Hsie L, Topaloglou T, Hubbell E, Robinson E,Mittmann M, Morris M S, Shen N, Kilburn D, Rioux J, Nusbaum C, Rozen S,Hudson T J, Lipshutz R, Chee M, Lander E S, Science. 1998 May 15;280(5366):1077-82). Other high-throughput methods discriminate allelesby differential hybridization, primer extension, ligation and cleavageof an allele-specific probe (Review Accessing genetic variation:genotyping single nucleotide polymorphisms, Syvänen AC, Nat Rev Genet.2001 December; 2(12):930-42; Review Techniques patents for SNPgenotyping, Twyman R M, Primrose S B, Pharmacogenomics. 2003 January;4(1):67-79).

An approach for a fully automated, large-scale SNP analysis is the‘homogeneous’ assay, i.e. a single-phase assay without separation steps,permitting continual monitoring during amplification. The TaqMan™ assay(Applied Biosystems), originally designed for quantitative real-timePCR, is a homogeneous, single-step assay also used in determination ofmutation status of DNA (see, eg, A. A. Komar (ed.), Single NucleotidePolymorphisms, Methods in Molecular Biology 578, DOI10.1007/978-1-60327-411-1_(—)19, Humana Press, a part of SpringerScience+Business Media, LLC; and Single Nucleotide Polymorphisms,Methods in Molecular Biology™ Volume 578, 2009, pp 293-306, The TaqManMethod for SNP Genotyping, Gong-Qing Shen et al). The TaqMan SNPGenotyping Assay exploits the 5′-exonuclease activity of AmpliTaq Gold™DNA polymerase to cleave a doubly labeled probe hybridized to theSNP-containing sequence of ssDNA. Cleavage separates a 5′-fluorophorefrom a 3′-quencher leading to detectable fluorescent signal. The use oftwo allele-specific probes carrying different fluorophores permits SNPdetermination in the same tube without any post-PCR processing. Genotypeis determined from the ratio of intensities of the two fluorescentprobes at the end of amplification. Thus, rather than taking advantageof the full set of real-time PCR data as in quantitative studies, onlyend-point data are used.

TaqMan SNP genotyping in a high-throughput, automated manner isfacilitated by the use of validated Pre-made TaqMan® Genotyping assays,but Custom TaqMan® Assays may also be used (High-throughput genotypingwith single nucleotide polymorphisms, Ranade K, Chang M S, Ting C T, PeiD, Hsiao C F, Olivier M, Pesich R, Hebert J, Chen Y D, Dzau V J, Curb D,Olshen R, Risch N, Cox D R, Botstein D, Genome Res. 2001 July;11(7):1262-8; Assessment of two flexible and compatible SNP genotypingplatforms: TaqMan SNP Genotyping Assays and the SNPlex GenotypingSystem, De la Vega F M, Lazaruk K D, Rhodes M D, Wenz M H, Mutat Res.2005 Jun. 3; 573(1-2):111-35). The results of the assay can beautomatically determined by genotyping software provided with real-timethermal cyclers (e.g. IQ software of Bio-Rad, Sequence DetectionSoftware of Applied Biosystems).

Single nucleotide polymorphisms (SNPs) can be determined using TaqMan™real-time PCR assays (Applied Biosystems) and commercial software thatassigns genotypes based on reporter probe signals at the end ofamplification. An algorithm for automatic genotype caling of SNPs usingthe full course of TaqMan real-time data is available for use (A.Callegaro et al, Nucleic Acids Res. 2006; 34(7): e56, Published online2006 Apr. 14. doi: 10.1093/nar/gk1185, PMCID: PMC1440877). The algorithmis unique in that it classifies samples according to the behavior ofblanks (no DNA samples), which cluster with heterozygous samples. Thismethod of classification eliminates the need for positive controls andpermits accurate genotyping even in the absence of a genotype class, forexample when one allele is rare.

The skilled person will be familiar with techniques that can be used foraccurate phenotyping and application to the invention. These include theuse of amino acid sequencing of isolated target protein and comparisonof sequences from different variants (eg, with the most common variant).An antibody that specifically and selectively binds in the area of a SNPunder stringent conditions can also be used to identify a particularvariant. In another method, the genotype is determined and acorresponding amino acid sequence (phenotype) determined, eg, by insilico translation.

Therapeutic Administration and Formulations

The invention provides therapeutic compositions comprising the anti-TOIligand, eg, antibodies or antigen-binding fragments thereof, of thepresent invention. The administration of therapeutic compositions inaccordance with the invention will be administered with suitablecarriers, excipients, and other agents that are incorporated intoformulations to provide improved transfer, delivery, tolerance, and thelike. A multitude of appropriate formulations can be found in theformulary known to all pharmaceutical chemists: Remington'sPharmaceutical Sciences, Mack Publishing Company, Easton, Pa. Theseformulations include, for example, powders, pastes, ointments, jellies,waxes, oils, lipids, lipid (cationic or anionic) containing vesicles(such as LIPOFECTINT™), DNA conjugates, anhydrous absorption pastes,oil-in-water and water-in-oil emulsions, emulsions carbowax(polyethylene glycols of various molecular weights), semi-solid gels,and semi-solid mixtures containing carbowax. See also Powell et al.“Compendium of excipients for parenteral formulations” PDA (1998) JPharm Sci Technol 52:238-311.

The dose may vary depending upon the age and the size of a subject to beadministered, target disease, conditions, route of administration, andthe like. When the ligand, eg, antibody, of the present invention isused for treating various conditions and diseases associated with theTOI in an adult patient, it is advantageous to intravenously administerthe antibody of the present invention normally at a single dose of about0.01 to about 20 mg/kg body weight, more preferably about 0.02 to about7, about 0.03 to about 5, or about 0.05 to about 3 mg/kg body weight.Depending on the severity of the condition, the frequency and theduration of the treatment can be adjusted.

Various delivery systems are known and can be used to administer theligand or pharmaceutical composition of the invention, for example aligand provided by e.g., encapsulation in liposomes, microparticles,microcapsules, recombinant cells capable of expressing the mutantviruses, receptor mediated endocytosis (see, e.g., Wu et al. (1987) J.Biol. Chem. 262:4429-4432). Methods of introduction include, but are notlimited to, intradermal, intramuscular, intraperitoneal, intravenous,subcutaneous, intranasal, epidural, and oral routes. The ligand orcomposition may be administered by any convenient route, for example byinfusion or bolus injection, by absorption through epithelial ormucocutaneous linings (e.g., oral mucosa, rectal and intestinal mucosa,etc.) and may be administered together with other biologically activeagents. Administration can be systemic or local.

The ligand or pharmaceutical composition can be also delivered in avesicle, in particular a liposome (see Langer (1990) Science249:1527-1533; Treat et al. (1989) in Liposomes in the Therapy ofInfectious Disease and Cancer, Lopez Berestein and Fidler (eds.), Liss,New York, pp. 353-365; Lopez-Berestein, ibid., pp. 317-327; seegenerally ibid.).

In certain situations, the ligand or pharmaceutical composition can bedelivered in a controlled release system. In one embodiment, a pump maybe used (see Langer, supra; Sefton (1987) CRC Crit. Ref. Biomed. Eng.14:201). In another embodiment, polymeric materials can be used; see,Medical Applications of Controlled Release, Langer and Wise (eds.), CRCPres., Boca Raton, Fla. (1974). In yet another embodiment, a controlledrelease system can be placed in proximity of the composition's target,thus requiring only a fraction of the systemic dose (see, e.g., Goodson,in Medical Applications of Controlled Release, supra, vol. 2, pp.115-138, 1984).

The injectable preparations may include dosage forms for intravenous,subcutaneous, intracutaneous and intramuscular injections, dripinfusions, etc. These injectable preparations may be prepared by methodspublicly known. For example, the injectable preparations may beprepared, e.g., by dissolving, suspending or emulsifying the antibody orits salt described above in a sterile aqueous medium or an oily mediumconventionally used for injections. As the aqueous medium forinjections, there are, for example, physiological saline, an isotonicsolution containing glucose and other auxiliary agents, etc., which maybe used in combination with an appropriate solubilizing agent such as analcohol (e.g., ethanol), a polyalcohol (e.g., propylene glycol,polyethylene glycol), a nonionic surfactant [e.g., polysorbate 80,HCO-50 (polyoxyethylene (50 mol) adduct of hydrogenated castor oil)],etc. As the oily medium, there are employed, e.g., sesame oil, soybeanoil, etc., which may be used in combination with a solubilizing agentsuch as benzyl benzoate, benzyl alcohol, etc. The injection thusprepared is preferably filled in an appropriate ampoule. Apharmaceutical composition of the present invention can be deliveredsubcutaneously or intravenously with a standard needle and syringe. Inaddition, with respect to subcutaneous delivery, a pen delivery devicereadily has applications in delivering a pharmaceutical composition ofthe present invention. Such a pen delivery device can be reusable ordisposable. A reusable pen delivery device generally utilizes areplaceable cartridge that contains a pharmaceutical composition. Onceall of the pharmaceutical composition within the cartridge has beenadministered and the cartridge is empty, the empty cartridge can readilybe discarded and replaced with a new cartridge that contains thepharmaceutical composition. The pen delivery device can then be reused.In a disposable pen delivery device, there is no replaceable cartridge.Rather, the disposable pen delivery device comes prefilled with thepharmaceutical composition held in a reservoir within the device. Oncethe reservoir is emptied of the pharmaceutical composition, the entiredevice is discarded.

Numerous reusable pen and autoinjector delivery devices haveapplications in the subcutaneous delivery of a ligand or pharmaceuticalcomposition of the present invention. Examples include, but certainlyare not limited to AUTOPEN™ (Owen Mumford, Inc., Woodstock, UK),DISETRONIC™ pen (Disetronic Medical Systems, Burghdorf, Switzerland),HUMALOG MIX 75/25™ pen, HUMALOG™ pen, HUMALIN 70/30™ pen (Eli Lilly andCo., Indianapolis, Ind.), NOVOPEN™I, II and III (Novo Nordisk,Copenhagen, Denmark), NOVOPEN JUNIOR™ (Novo Nordisk, Copenhagen,Denmark), BD™ pen (Becton Dickinson, Franklin Lakes, N.J.), OPTIPENT™,OPTIPEN PRO™, OPTIPEN STARLET™, and OPTICLIKT™ (sanofi-aventis,Frankfurt, Germany), to name only a few. Examples of disposable pendelivery devices having applications in subcutaneous delivery of apharmaceutical composition of the present invention include, butcertainly are not limited to the SOLOSTAR™ pen (sanofi-aventis), theFLEXPEN™ (Novo Nordisk), and the KWIKPEN™ (Eli Lilly).

Advantageously, the pharmaceutical compositions for oral or parenteraluse described above are prepared into dosage forms in a unit dose suitedto fit a dose of the ligand(s). Such dosage forms in a unit doseinclude, for example, tablets, pills, capsules, injections (ampoules),suppositories, etc. The amount of the aforesaid antibody contained isgenerally about 5 to about 500 mg per dosage form in a unit dose;especially in the form of injection, it is preferred that the aforesaidantibody is contained in about 5 to about 100 mg and in about 10 toabout 250 mg for the other dosage forms.

Exemplary TOIs

For example in any configuration, aspect, concept, example orconfiguration of the invention, the or each TOI is selected from thegroup consisting of ABCF1; ACVR1; ACVR1B; ACVR2; ACVR2B; ACVRL1;ADORA2A; Aggrecan; AGR2; AICDA; AWl; AIG1; AKAP1; AKAP2; AIYIH;amyloid-beta; AMHR2; ANGPT1; ANGPT2; ANGPTL3; ANGPTL4; ANPEP; APC;APOC1; AR; Axl; AZGP1 (zinc-a-glycoprotein); B7.1; B7.2; BAD; BAFF;BAG1; BAIl; BCL2; BCL6; BDNF; BLNK; BLR1 (MDR15); B1yS; BMP1; BMP2;BMP3B (GDF1O); BMP4; BMP6; BMP8; BMPR1A; BMPR1B; BMPR2; BPAG1 (plectin);BRCA1; Cl9orflO (IL27w); C3; C4A; C5; C5R1; CANT1; CASP1; CASP4; CAV1;CB1; CCBP2 (D6/JAB61); CCL1 (1-309); CCL11 (eotaxin); CCL13 (MCP-4);CCL15 (MIP-id); CCL16 (HCC-4); CCL17 (TARC); CCL18 (PARC); CCL19(MIP-3b); CCL2 (MCP-1); MCAF; CCL2O (MIP-3a); CCL21 (MIP-2); SLC;exodus-2; CCL22 (MDC/STC-1); CCL23 (MPIF-1); CCL24 (MPIF-2 I eotaxin-2);CCL25 (TECK); CCL26 (eotaxin-3); CCL2? (CTACK/ILC); CCL28; CCL3(MIP-la); CCL4 (MIP-1b); CCL5 (RANTES); CCL7 (MCP-3); CCL8 (mcp-2);CCNA1; CCNA2; CCND1; CCNE1; CCNE2; CCR1 (CKR1/HM145); CCR2 (mcp-1RB/RA);CCR3 (CKR3/CMKBR3); CCR4; CCR5 (CMKBR5/ChemR13); CCR6(CMKBR6/CKR-L3/STRL22/DRY6); CCR7 (CKR7/EBI1); CCR8(CMKBR8/TERI/CKR-L1); CCR9 (GPR-9-6); CCRL1 (VSHK1); CCRL2 (L-CCR); CD7,CD164; CD19; CD1C; CD2O; CD200; CD-22; CD24; CD28; CD3; CD37; CD38;CD3E; CD3G; CD3Z; CD4; CD4O; CD4OL; CD44; CD45RB; CD52; CD69; CD72;CD74; CD79A; CD79B; CD8; CD8O; CD81; CD83; CD86; CD96; CD207; CDH1(E-cadherin); CDH10; CDH12; CDH13; CDH18; CDH19; CDH2O; CDHS; CDH7;CDH8; CDH9; CDK2; CDK3; CDK4; CDKS; CDK6; CDK7; CDK9; CDKN1A(p21Wapl/Cipl); CDKN1B (p27Kipl); CDKNIC; CDKN2A (p161NK4a); CDKN2B;CDKN2C; CDKN3; CEBPB; CELSR3; CER1; CHGA; CHGB; Chitinase; CHRNG;CHST10; CKLFSF2; CKLFSF3; CKLFSF4; CKLFSFS; CKLFSF6; CKLFSF7; CKLFSF8;CLDN3; CLDN7 (claudin-7); CLN3; CLU (clusterin); CMKLR1; CMKOR1 (RDC1);CNR1; COL18A1; COL1A1; COL4A3; COL6A1; CR2; CRP; CSF1 (M-CSF); CRLF2;CSF2 (GM-CSF); CSF3 (GCSF); CTLA4; CTNNB1 (b-catenin); CTSB (cathepsinB); CX3CL1 (SCYDi); CX3CR1 (V28); CXCR6; CXCL1 (GRO1); CXCL1O (IP-10);CXCL11 (I-TAC/IP-9); CXCL12 (SDF1); CXCL13; CXCL14; CXCL16; CXCL2(GRO2); CXCL3 (GRO3); CXCL5 (ENA-78 I LIX); CXCL6 (GCP-2); CXCL9 (MIG);CXCR3 (GPR9/CKR-L2); CXCR4; CXCR6 (TYMSTR ISTRL33 I Bonzo); CYB5; CYC1;CYSLTR1; DAB2IP; DAND5; DES; DKFZp451J0118; DNCL1; DPP4; E2F1; ECGF1;EDG1; EFNAI; EFNA3; EFNB2; EGF; EGFR; ELAC2; ENG; ENO1; ENO2; ENO3;EphA4; EPHB4; EPO; ERBB2 (Her-2); EREG; ERK8; ESR1; ESR2; F3 (TF); FADD;FasL; FASN; FCER1A; FCER2; FCGR3A; FCRL4; FGF; FGF1 (aFGF); FGF1O;FGF11; FGF12; FGF12B; FGF13; FGF14; FGF16; FGF17; FGF18; FGF19; FGF2(bFGF); FGF2O; FGF21; FGF22; FGF23; FGF3 (int-2); FGF4 (HST); FGF5; FGF6(HST-2); FGF7 (KGF); FGF8; FGF9; FGFR3; FIGF (VEGFD); FIL1 (EPSILON);FIL1 (ZETA); FLJ12584; FLJ25530; FLRT1 (fibronectin); FLT1; FOS; FOSL1(FRA-1); FY (DARC); GABRP (GABAa); GAGEB1; GAGEC1; Galectin-3;GALNAC4S-65T; GATA3; GDF5; GFI1; GGT1; GHR; GM-CSF; GNAS1; GNRH1; GPR2(CCR1O); GPR31; GPR44; GPR81 (FKSG8O); GPR87; GPR137C; GRCC10 (C10);GRP; GSN (Gelsolin); GSTP1; HAVCR1; HAVCR2; HDAC4; EDAC5; HDAC7A; HDAC9;hepcidin; hemojuvelin; HGF; HIF1A; HIP1; histamine and histaminereceptors; HLA-A; HLA-DRA; HM74; HMOX1; HUMCYT2A; ICEBERG; ICOS; 1D2;IFN-a; IFNA1; IFNA2; IFNA4; IFNA5; IFNA6; IFNA7; IFNB1; IFNgamma; TFNW1;IGBP1; IGF1; IGF1R; IGF2; IGFBP2; IGFBP3; IGFBP6; IL-1; IL10; IL1ORA;IL1ORB; IL11; IL11RA; IL-12; IL12A; IL12B; IL12RB1; IL12RB2; 1L13;IL13RA1; IL13RA2; 1L14; 1L15; IL15RA; IL16; 1L17; IL17B; IL17C; IL17R;1L18; IL18BP; IL18R1; IL18RAP; 1L19; IL1A; IL1B; IL1F1O; IL1F5; IL1F6;IL1F7; IL1F8; IL1F9; IL1HY1; IL1R1; IL1R2; IL1RAP; IL1RAPL1; IL1RAPL2;IL1RL1; IL1RL2 IL1RN; 1L2; 1L20; IL2ORA; IL21R; 1L22; 1L22R; 1L22RA2;1L23; 1L24; 1L25; 1L26; 1L27; 1L28A; 1L28B; 1L29; IL2RA; IL2RB; IL2RG;1L3; 1L30; IL3RA; 1L4; IL4R; 1L5; IL5RA; 1L6; IL6 receptor; IL6ST(glycoprotein 130); 1L7; TL7R; 1L8; IL8RA; IL8RB; IL8RB; 1L9; IL9R; ILK;INHA; INHBA; INSL3; INSL4; IRAK1; IRAK2; ITGA1; ITGA2; 1TGA3; ITGA6 (a6integrin); ITGAV; ITGB3; ITGB4 (b 4 integrin); JAG1; JAK1; JAK3; JUN;K6HF; KAI1; KDR; MTLG; KLF5 (GC Box BP); KLF6; KLK10; KLK12; KLK13;KLK14; KLK15; KLK3; KLK4; KLK5; KLK6; KLK9; KRT1; KRT19 (Keratin 19);KRT2A; KRTHB6 (hair-specific type II keratin); LAG3; LAMAS; LEP(leptin); LIGHT; Lingo-p75; Lingo-Troy; LPS; LRP5; LTA (TNF-b); LTB;LTB4R (GPR16); LTB4R2; LTBR; MACMARCKS; MAG or Omgp; MAP2K7 (c-Jun);MDK; MIB1; midkine; MIF; MIP-2; MK167 (Ki-67); MMP2; MMP9; MS4A1; MSMB;MT3 (metallothionectin-ifi); MTSS 1; MUC 1 (mucin); MYC; MYD88; NCK2;neurocan; Na_(v)1.7; Na_(v)1.8; NFKB 1; NFKB2; NGFB (NGF); NGFR;NgR-Lingo; NgR-Nogo66 (Nogo); NgR-p75; NgR-Troy; NME1 (NM23A); NOX5;NPPB; NROB1; NROB2; NR1D1; NR1D2; NR1H2; NR1H3; NR1H4; NR1I2; NR1I3;NR2C1; NR2C2; NR2E1; NR2E3; NR2F1; NR2F2; NR2F6; NR3C1; NR3C2; NR4A1;NR4A2; NR4A3; NR5A1; NR5A2; NR6A1; NRP1; NRP2; NT5E; NTN4; ODZ1; OPG;OPRD1; OX4OL; OX40; P2RX7; PAP; PART1; PATE; PAWR; PCA3; PCNA; PCSK9,PD-1, PD-L1; PDGFA; PDGFB; PECAM1; PF4 (CXCL4); PGF; PGR; phosphacan;PIAS2; Placental Growth Factor (PIGF); PIK3CG; PLAU (uPA); PLG; PLXDC1;PPBP (CXCL7); PPID; PR1; PRKCQ; PRKD1; PRL; PROC; PROK2; PSAP; PSCA;PTAFR; PTEN; PTGS2 (COX-2); PTN; RAC2 (p21Rac2); RARB; RGS1; RGS13;RGS3; RNF11O (ZNF144); ROBO2; ROR1; S100A2; SCGB1D2 (lipophilin B);SCGB2A1 (mammaglobin 2); SCGB2A2 (mammaglobin 1); SCYE1 (endothelialMonocyte-activating cytokine); SDF2; SERPINA1; SERPINIA3; SERPINB5(maspin); SERPINE1 (PAT-i); SERPINF1; SHBG; SLA2; SLC2A2; SLC33A1;SLC43A1; SLIT2; SPP1; SPRR1B (Spri); ST6GAL1; STAB1; STATE; STEAP;STEAP2; TB4R2; TBX21; TCP10; TDGF1; TEK; TGFA; TGFB1; TGFB1I1; TGFB2;TGFB3; TGFBI; TGFBR1; TGFBR2; TGFBR3; TH1L; THB S1 (thrombospondin-1);THB S2; THB S4; THPO; TIE (Tie-i); TIM3; TMP3; tissue factor; TLR10;TLR2; TLR3; TLR4; TLR5; TLR6; TLR7; TLR8; TLR9; TMPRSS6; TNF; TNF-α;TNFAIP2 (B94); TNFAIP3; TNFRSF1 1A; TNFRSF1A; TNFRSF1B; TNFRSF21;TNFRSF5; TNFRSF6 (Fas); TNFRSF7; TNFRSF8; TNFRSF9; TNFSF1O (TRAIL);TNFSF1 1 (TRANCE); TNFSF12 (APO3L); TNFSF13 (April); TNFSF13B; TNFSF14(HVEM-L); TNFSF1 5 (VEGI); TNFSF1 8; TNFSF4 (0X40 ligand); TNFSF5 (CD4Oligand); TNFSF6 (FasL); TNFSF7 (CD27 ligand); TNFSF8 (CD3O ligand);TNFSF9 (4-1BB ligand); TOLLIP; Toll-like receptors; TOP2A (topoisomeraselia); TP53; TPM1; TPM2; TRADD; TRAF1; TRAF2; TRAF3; TRAF4; TRAF5; TRAF6;TRAIL; TREM1; TREM2; TRPC6; TSLP; TWEAK; VEGFA; VEGFB; VEGFC; versican;VHL C5; VLA-4; Wnt7A; XCL1 (lymphotactin); XCL2 (SCM-1b); XCR1(GPR5/CCXCR1); YY1; and ZFPM2.

In an example, the TOI is a human TOI selected from Table 5.

In an example, the TOI is OX40 ligand.

In an example, the TOI is OX40.

In an example, the TOI is PCSK9.

In an example, the TOI is IL6 receptor (IL-6R).

In an example, the TOI is LIGHT.

In an example, the TOI is VEGF-A.

In an example, the TOI is TNF alpha.

In an example, the TOI is PIGF.

In an example, the TOI is IGF1R.

In an example, the TOI is OPG.

In an example, the TOI is ICOS

In an example, the TOI is NGF.

In an example, the TOI is BMP6.

In an example, the TOI is ferroportin.

In an example, the TOI is TMPRSS6.

In an example, the TOI is hemojuvelin.

In an example, the TOI is VEGF receptor.

In an example, the TOI is PDGF receptor.

In an example, the TOI is stem cell factor receptor.

In an example, the TOI is hepcidin.

In an example, the TOI is IL-4 receptor alpha.

In an example, the TOI is sclerostin.

In an example, the TOI is IL-13 receptor.

In an example, the TOI is CD7.

In an example, the TOI is delta-like ligand-4 (D114).

In an example, the TOI is HGF.

In an example, the TOI is angiopoietin-2 (Ang2).

In an example, the TOI is GDF8.

In an example, the TOI is ERBB3.

In an example, the TOI is IL-17 receptor.

In an example, the TOI is CD40.

In an example, the TOI is CD40 ligand.

In an example, the TOI is EGFR.

In an example, the TOI comprises a mutation as described herein for thatTOI or is encoded by a nucleotide sequence comprising a SNP as describedherein for that TOI. Optionally, additionally the human comprises saidTOI comprising said mutation; or the human comprises a nucleotidesequence encoding said TOI comprising said mutation.

For example, the TOI is human PCSK9 and comprises a mutation I474,E670G, N425S or Q619P in SEQ ID NO: 1. Optionally, additionally thehuman comprises said PCSK9 comprising said mutation; or the humancomprises a nucleotide sequence encoding said PCSK9 comprising saidmutation. In an alternative, for example herein where a PCSK9 is statedto be of a specific “form”, eg, form f, c, r, p, e, h, aj or q, in thealternative the PCSK9 is a human PCSK9 comprising a mutation R46L, A53V,N425S, A443T, I474V, Q619P and E670G (eg, comprises a mutation I474,E670G, N425S or Q619P) in SEQ ID NO: 1; for example, the PCSK9 comprisesI474V in SEQ ID NO: 1 and optionally the human comprises such a PCSK9 ora nucleotide sequence encoding such a PCSK9 (eg, wherein the method isfor treating or preventing dislipidemia, eg reducing cholesterol ormaintaining reduced cholesterol in the human); for example, the PCSK9comprises E670G in SEQ ID NO: 1 and optionally the human comprises sucha PCSK9 or a nucleotide sequence encoding such a PCSK9 (eg, wherein themethod is for treating or preventing dislipidemia, eg reducingcholesterol or maintaining reduced cholesterol in the human); forexample, the PCSK9 comprises Q619P in SEQ ID NO: 1 and optionally thehuman comprises such a PCSK9 or a nucleotide sequence encoding such aPCSK9 (eg, wherein the method is for treating or preventingdislipidemia, eg reducing cholesterol or maintaining reduced cholesterolin the human); for example, the PCSK9 comprises N425S in SEQ ID NO: 1and optionally the human comprises such a PCSK9 or a nucleotide sequenceencoding such a PCSK9 (eg, wherein the method is for treating orpreventing dislipidemia, eg reducing cholesterol or maintaining reducedcholesterol in the human); for example, the PCSK9 comprises R46L in SEQID NO: 1 and optionally the human comprises such a PCSK9 or a nucleotidesequence encoding such a PCSK9 (eg, wherein the method is for treatingor preventing dislipidemia, eg increasing cholesterol in the human); forexample, the PCSK9 comprises A53V in SEQ ID NO: 1 and optionally thehuman comprises such a PCSK9 or a nucleotide sequence encoding such aPCSK9 (eg, wherein the method is for treating or preventingdislipidemia, eg increasing cholesterol in the human); for example, thePCSK9 comprises A443T in SEQ ID NO: 1 and optionally the human comprisessuch a PCSK9 or a nucleotide sequence encoding such a PCSK9 (eg, whereinthe method is for treating or preventing dislipidemia, eg increasingcholesterol in the human).

For example, the TOI is human IL6R and comprises a mutation D358A orV385I in SEQ ID NO: 78. Optionally, additionally the human comprisessaid IL6R comprising said mutation; or the human comprises a nucleotidesequence encoding said IL6R comprising said mutation.

For example, the TOI is human IL4Ra and comprises a mutation selectedfrom the group consisting of I75V, E400A, C431R, S503P, Q576R and S752Ain SEQ ID NO: 67. Optionally, additionally the human comprises saidIL4Ra comprising said mutation; or the human comprises a nucleotidesequence encoding said IL4Ra comprising said mutation.

For example, the TOI is human Nav1.7 and comprises a mutation selectedfrom the group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X(wherein X is an amino acid other than R), 328X (wherein X is an aminoacid other than Y), 395K, 459X (wherein X is an amino acid other thanS), 693 X (wherein X is an amino acid other than E), 767X (wherein X isan amino acid other than I), 830X (wherein X is an amino acid other thanR), 897X (wherein X is an amino acid other than W), 1200L, 1235L, 1488X(wherein X is an amino acid other than R), 1659X (wherein X is an aminoacid other than K), 1689X (wherein X is an amino acid other than W),422D, 490N, 943L, 1002L, 1161W and 1919G, eg, the mutation is 1161W.Optionally, additionally the human comprises said Nav1.7 comprising saidmutation; or the human comprises a nucleotide sequence encoding saidNav1.7 comprising said mutation.

For example, the TOI is human VEGF-A and is encoded by a VEGF-Anucleotide sequence comprising a SNP selected from the group consistingof rs699947, rs833061, rs2010963, rs3025039, rs699946, rs2146323,rs1413711, rs833068, rs833069, rs3025000 and rs1570360. Optionally,additionally the human comprises said VEGF-A comprising said mutation;or the human comprises a nucleotide sequence encoding said VEGF-Acomprising said mutation.

For example, the TOI is human PDGF-B and is encoded by a PDGF-Bnucleotide sequence comprising a SNP selected from the group consistingof rs142404523 (ie, a C corresponding to position −776) and a C at theposition of rs1800818 (ie, a C corresponding to position −735).Optionally, additionally the human comprises said PDGF-B comprising saidmutation; or the human comprises a nucleotide sequence encoding saidPDGF-B comprising said mutation.

For example, the TOI is human PDGFR-B and is encoded by a PDGFR-Bnucleotide sequence comprising a SNP selected from the group consistingof rs246395 (ie, a G corresponding to position 2601) and rs74943037 (ie,a T corresponding to position 1391). Optionally, additionally the humancomprises said PDGFR-B comprising said mutation; or the human comprisesa nucleotide sequence encoding said PDGFR-B comprising said mutation.

For convenience, the meaning of some terms and phrases used in thespecification, examples, and appended claims, are provided below. Unlessstated otherwise, or implicit from context, the following terms andphrases include the meanings provided below. The definitions areprovided to aid in describing particular embodiments, and are notintended to limit the claimed invention, because the scope of theinvention is limited only by the claims. Unless otherwise defined, alltechnical and scientific terms used herein have the same meaning ascommonly understood by one of ordinary skill in the art to which thisinvention belongs. If there is an apparent discrepancy between the usageof a term in the art and its definition provided herein, the definitionprovided within the specification shall prevail.

For convenience, certain terms employed herein, in the specification,examples and appended claims are collected here.

The terms “decrease”, “reduced”, or “reduction” are all used herein tomean a decrease by a statistically significant amount. In someembodiments, “reduce,” “reduction” or “decrease” typically means adecrease by at least 10% as compared to a reference level (e.g. theabsence of a given treatment) and can include, for example, a decreaseby at least about 10%, at least about 20%, at least about 25%, at leastabout 30%, at least about 35%, at least about 40%, at least about 45%,at least about 50%, at least about 55%, at least about 60%, at leastabout 65%, at least about 70%, at least about 75%, at least about 80%,at least about 85%, at least about 90%, at least about 95%, at leastabout 98%, at least about 99%, or more. As used herein, “reduction” doesnot encompass a complete reduction as compared to a reference level. Adecrease can be preferably down to a level accepted as within the rangeof normal for an individual without a given disorder. However, forexample, for the purposes of lowering or reducing cholesterol level, forexample, a reduction by about 5-10 points can be considered a “decrease”or “reduction.”

In certain aspects of all embodiments of the invention, the term“inhibition” is used. Inhibition refers and refers to decrease by atleast 10% as compared to a reference level (e.g. the absence of a giventreatment) and can include, for example, a decrease by at least about10%, at least about 20%, at least about 25%, at least about 30%, atleast about 35%, at least about 40%, at least about 45%, at least about50%, at least about 55%, at least about 60%, at least about 65%, atleast about 70%, at least about 75%, at least about 80%, at least about85%, at least about 90%, at least about 95%, at least about 98%, atleast about 99%, or more including 100% inhibition as compared to areference level. “Complete inhibition” refers to a 100% inhibition ascompared to a reference level.

The terms “increased”, “increase”, “enhance”, or “activate” are all usedherein to mean an increase by a statically significant amount. In someembodiments, the terms “increased”, “increase”, “enhance”, or “activate”can mean an increase of at least 10% as compared to a reference level,for example an increase of at least about 20%, or at least about 30%, orat least about 40%, or at least about 50%, or at least about 60%, or atleast about 70%, or at least about 80%, or at least about 90% or up toand including a 100% increase or any increase between 10-100% ascompared to a reference level, or at least about a 2-fold, or at leastabout a 3-fold, or at least about a 4-fold, or at least about a 5-foldor at least about a 10-fold increase, or any increase between 2-fold and10-fold or greater as compared to a reference level. In the context of amarker or symptom, an “increase” is a statistically significant increasein such level.

As used herein, the term “substantially” refers to the qualitativecondition of exhibiting total or near-total extent or degree of acharacteristic or property of interest. One of ordinary skill in thebiological arts will understand that biological and chemical phenomenararely, if ever, go to completion and/or proceed to completeness orachieve or avoid an absolute result. The term “substantially” istherefore used herein to capture the potential lack of completenessinherent in many biological and chemical phenomena. For the removal ofdoubt, “substantially” can refer to at least a 90% extent or degree of acharacteristic or property of interest, e.g. at least 90%, at least 92%,at least 95%, at least 98%, at least 99% or greater.

As used herein, a “subject” means a human or animal. Usually the animalis a vertebrate such as a primate, rodent, domestic animal or gameanimal Primates include chimpanzees, cynomologous monkeys, spidermonkeys, and macaques, e.g., Rhesus. Rodents include mice, rats,woodchucks, ferrets, rabbits and hamsters. In some embodiments, thesubject is a mammal, e.g., a primate, e.g., a human. The terms,“individual,” “patient” and “subject” are used interchangeably herein.In some embodiments, the subject can be a non-human vertebrate, e.g. aprimate, a rodent, a mouse, a rat, a pig, a sheep, a zebrafish, a frog,etc.

Preferably, the subject is a mammal The mammal can be a human, non-humanprimate, mouse, rat, dog, cat, horse, or cow, but is not limited tothese examples. Mammals other than humans can be advantageously used assubjects that represent animal models of a disease or condition, e.g., acardiovascular condition. A subject can be male or female.

A subject can be one who has been previously diagnosed with oridentified as suffering from or having a condition in need of treatmentor one or more complications related to such a condition, andoptionally, have already undergone treatment for the condition or theone or more complications related to the condition. Alternatively, asubject can also be one who has not been previously diagnosed as havingthe condition or one or more complications related to the condition. Forexample, a subject can be one who exhibits one or more risk factors forthe condition or one or more complications related to the condition or asubject who does not exhibit risk factors.

A “subject in need” or “human in need” of treatment for a particularcondition can be a subject having that condition, such as increasedcholesterol levels, diagnosed as having that condition, or at risk ofdeveloping that condition.

As used herein, the terms “protein” and “polypeptide” are usedinterchangeably herein to designate a series of amino acid residues,connected to each other by peptide bonds between the alpha-amino andcarboxy groups of adjacent residues. The terms “protein”, and“polypeptide” refer to a polymer of amino acids with natural aminoacids. When referring to “modified polypeptides” one refers topolypeptides that include modified amino acids (e.g., phosphorylated,glycated, glycosylated, etc.) and amino acid analogs, regardless of itssize or function. “Protein” and “polypeptide” are often used inreference to relatively large polypeptides, whereas the term “peptide”is often used in reference to small polypeptides, but usage of theseterms in the art overlaps. The terms “protein” and “polypeptide” areused interchangeably herein when referring to a gene product andfragments thereof. Thus, exemplary polypeptides or proteins include geneproducts, naturally occurring proteins with the specified sequence. Onecan also use peptide homologs, peptide orthologs, peptide paralogs,peptide fragments and other equivalents, variants, fragments, andanalogs of the peptides as these terms are understood by one of ordinaryskill in the art.

As used herein, the term “nucleic acid” or “nucleic acid sequence”refers to any molecule, preferably a polymeric molecule, incorporatingunits of ribonucleic acid, deoxyribonucleic acid. The nucleic acid canbe either single-stranded or double-stranded. A single-stranded nucleicacid can be one nucleic acid strand of a denatured double-stranded DNA.Alternatively, it can be a single-stranded nucleic acid not derived fromany double-stranded DNA. In one aspect, the nucleic acid can be DNA. Inanother aspect, the nucleic acid can be RNA. Suitable nucleic acidmolecules are DNA, including genomic DNA or cDNA. Other suitable nucleicacid molecules are RNA, including mRNA. In some aspects one can also useanalogs of nucleic acids.

As used herein, the term “nucleic acid probe” refers to an isolatedoligonucleotide molecule having a nucleic acid sequence which canhybridize to a target nucleic acid sequence, e.g. specifically hybridizeto the target sequence. In some embodiments, a nucleic acid probe canfurther comprise a detectable label. In some embodiments, a nucleic acidprobe can be attached to a solid surface. In some embodiments, a nucleicacid from is from about 5 nt to about 100 nt in length.

As used herein, the term “siRNA” refers to a nucleic acid that forms anRNA molecule comprising two individual strands of RNA which aresubstantially complementary to each other. Typically, the siRNA is atleast about 15-40 nucleotides in length (e.g., each complementarysequence of the double stranded siRNA is about 15-40 nucleotides inlength, and the double stranded siRNA is about 15-40 base pairs inlength, preferably about 19-25 base nucleotides, e.g., 19, 20, 21, 22,23, 24, or 25 nucleotides in length). In some embodiments, a siRNA canbe blunt-ended. In some embodiments, a siRNA can comprise a 3′ and/or 5′overhang on each strand having a length of about 0, 1, 2, 3, 4, or 5nucleotides. The length of the overhang is independent between the twostrands, i.e., the length of the overhang on one strand is not dependenton the length of the overhang on the second strand. The siRNA moleculescan also comprise a 3′ hydroxyl group. In some embodiments, the siRNAcan comprise a 5′ phosphate group. A siRNA has the ability to reduce orinhibit expression of a gene or target RNA when the siRNA is present orexpressed in the same cell as the target gene, e.g. the target RNA.siRNA-dependent post-transcriptional silencing of gene expressioninvolves cutting the target RNA molecule at a site guided by the siRNA.

As used herein, “PCSK9” or “proprotein convertase subtilisin/kexin type9” refers to a serine protease involved in regulating the levels of thelow density lipoprotein receptor (LDLR) protein (Horton et al., 2007;Seidah and Prat, 2007). PCSK9 has been shown to directly interact withthe LDLR protein, be endocytosed along with the LDLR, andco-immunofluoresce with the LDLR throughout the endosomal pathway(Lagace et al., 2006). PCSK9 is a prohormone-proprotein convertase inthe subtilisin (S8) family of serine proteases (Seidah et al., 2003).The sequence of PCSK9 for a variety of species is known, e.g., humanPCSK9 (NCBI Gene ID No: 255738). Nucleotide and polypeptide sequencesfor a number of PCSK9 isoforms are provided herein, e.g., SEQ ID NOs:1-37.

PCSK9 exists as both a pro-form and a mature form. Autocatalysis of thePCSK9 proform occurs between Gln152 and Ser153 (VFAQ|SIP (SEQ ID NO:116)) (Naureckiene et al., 2003), and has been shown to be required forits secretion from cells (Seidah et al., 2003). The inactive form priorto this cleavage can be referred to herein as the “inactive”,“pro-form”, or “unprocessed” form of PCSK9. The C-terminal fragmentgenerated by the autocatalysis event can be referred to herein as the“mature,” “cleaved”, “processed” or “active” PCSK9. Examples of pro-formand mature PCSK9 isoforms are provided herein, see, e.g. SEQ ID NOs:1-27.

As used herein, the “catalytic domain” of PCSK9 refers to the portion ofa PCSK9 polypeptide corresponding to positions 153 to 449 of PCSK9, e.g.of SEQ ID NO: 1. As used herein, the “C-terminal domain” of PCSK9 refersto the portion of a PCSK9 polypeptide corresponding to positions 450-692of PCSK9, e.g., of SEQ ID NO: 1.

As used herein, a disease or condition “mediated by PCSK9” refers to adisease or condition which is caused by or characterized by a change inPCSK9, e.g. a change in expression level, a change in activity, and/orthe presence of a variant or mutation of PCSK9. Non-limiting examples ofsuch diseases or conditions can include, for example, a lipid disorder,hyperlipoproteinemia, hyperlipidemia; dyslipidemia;hypercholesterolemia, a heart attack, a stroke, coronary heart disease,atherosclerosis, peripheral vascular disease, claudication (eg,claudication associated with elevated cholesterol), type II diabetes,high blood pressure, and a cardiovascular disease or condition. Anotherexample is acute coronary syndrome. In an example, the disease orcondition is an inflammatory or autoimmune disease or condition. Methodsof identifying and/or diagnosing such diseases and conditions are wellknown to medical practitioners of ordinary skill.

A subject at risk of having or developing a disease or conditionmediated by PCSK9 can be a subject exhibiting one or more signs orsymptoms of such a disease or condition or having one or more riskfactors for such a disease or condition, e.g. being overweight, havingelevated cholesterol level, comprising one or more genetic polymorphismsknown to predispose to the disease or condition, e.g., elevatedcholesterol level, such as having a mutation in the LDLR (encodinglow-density lipoprotein receptor) or APOB (encoding apolipoprotein B) orin the PCSK9 gene and/or having a family history of such a disease orcondition.

As used herein, “ligand” refers to a molecule which can bind, e.g.,specifically bind, to a second molecule or receptor. In someembodiments, a ligand can be, e.g., an antibody, antibody fragment,antibody portion, and/or affibody.

The term “variant” as used herein refers to a peptide or nucleic acidthat differs from the polypeptide or nucleic acid (eg, the most commonone in humans, eg, most frequent in a database as disclosed herein, suchas the 1000 Genomes Project database) by one or more amino acid ornucleic acid deletions, additions, yet retains one or more specificfunctions or biological activities of the naturally occurring moleculeAmino acid substitutions include alterations in which an amino acid isreplaced with a different naturally-occurring amino acid residue. Suchsubstitutions may be classified as “conservative”, in which case anamino acid residue contained in a polypeptide is replaced with anothernaturally occurring amino acid of similar character either in relationto polarity, side chain functionality or size. Such conservativesubstitutions are well known in the art. Substitutions encompassed bythe present invention may also be “non-conservative”, in which an aminoacid residue which is present in a peptide is substituted with an aminoacid having different properties, such as naturally-occurring amino acidfrom a different group (e.g., substituting a charged or hydrophobicamino; acid with alanine), or alternatively, in which anaturally-occurring amino acid is substituted with a non-conventionalamino acid. In some embodiments amino acid substitutions areconservative. Also encompassed within the term variant when used withreference to a polynucleotide or polypeptide, refers to a polynucleotideor polypeptide that can vary in primary, secondary, or tertiarystructure, as compared to a reference polynucleotide or polypeptide,respectively (e.g., as compared to a wild-type polynucleotide orpolypeptide).

Variants of PCSK9 are provided elsewhere herein. Variants of PCSK9 caninclude the forms described herein as a, f, c, r, p, m, e h, aj, and q.Sequences of these variants are provided herein, see, e.g, SEQ IDNOs:1-27 and in Table 1, 2 or 6.

In some aspects, one can use “synthetic variants”, “recombinantvariants”, or “chemically modified” polynucleotide variants orpolypeptide variants isolated or generated using methods well known inthe art. “Modified variants” can include conservative ornon-conservative amino acid changes, as described below. Polynucleotidechanges can result in amino acid substitutions, additions, deletions,fusions and truncations in the polypeptide encoded by the referencesequence. Some aspects use include insertion variants, deletion variantsor substituted variants with substitutions of amino acids, includinginsertions and substitutions of amino acids and other molecules) that donot normally occur in the peptide sequence that is the basis of thevariant, for example but not limited to insertion of ornithine which donot normally occur in human proteins. The term “conservativesubstitution,” when describing a polypeptide, refers to a change in theamino acid composition of the polypeptide that does not substantiallyalter the polypeptide's activity. For example, a conservativesubstitution refers to substituting an amino acid residue for adifferent amino acid residue that has similar chemical properties.Conservative amino acid substitutions include replacement of a leucinewith an isoleucine or valine, an aspartate with a glutamate, or athreonine with a serine.

“Conservative amino acid substitutions” result from replacing one aminoacid with another having similar structural and/or chemical properties,such as the replacement of a leucine with an isoleucine or valine, anaspartate with a glutamate, or a threonine with a serine. Thus, a“conservative substitution” of a particular amino acid sequence refersto substitution of those amino acids that are not critical forpolypeptide activity or substitution of amino acids with other aminoacids having similar properties (e.g., acidic, basic, positively ornegatively charged, polar or non-polar, etc.) such that the substitutionof even critical amino acids does not reduce the activity of thepeptide, (i.e. the ability of the peptide to penetrate the blood brainbarrier (BBB)). Conservative substitution tables providing functionallysimilar amino acids are well known in the art. For example, thefollowing six groups each contain amino acids that are conservativesubstitutions for one another: 1) Alanine (A), Serine (S), Threonine(T); 2) Aspartic acid (D), Glutamic acid (E); 3) Asparagine (N),Glutamine (Q); 4) Arginine (R), Lysine (K); 5) Isoleucine (I), Leucine(L), Methionine (M), Valine (V); and 6) Phenylalanine (F), Tyrosine (Y),Tryptophan (W). (See also Creighton, Proteins, W. H. Freeman and Company(1984), incorporated by reference in its entirety.) In some embodiments,individual substitutions, deletions or additions that alter, add ordelete a single amino acid or a small percentage of amino acids can alsobe considered “conservative substitutions” if the change does not reducethe activity of the peptide. Insertions or deletions are typically inthe range of about 1 to 5 amino acids. The choice of conservative aminoacids may be selected based on the location of the amino acid to besubstituted in the peptide, for example if the amino acid is on theexterior of the peptide and expose to solvents, or on the interior andnot exposed to solvents.

In alternative embodiments, one can select the amino acid which willsubstitute an existing amino acid based on the location of the existingamino acid, i.e. its exposure to solvents (i.e. if the amino acid isexposed to solvents or is present on the outer surface of the peptide orpolypeptide as compared to internally localized amino acids not exposedto solvents). Selection of such conservative amino acid substitutionsare well known in the art, for example as disclosed in Dordo et al, J.MoI Biol, 1999, 217, 721-739 and Taylor et al, J. Theor. Biol.119(1986); 205-218 and S. French and B. Robson, J. MoI. Evol.19(1983)171. Accordingly, one can select conservative amino acidsubstitutions suitable for amino acids on the exterior of a protein orpeptide (i e amino acids exposed to a solvent), for example, but notlimited to, the following substitutions can be used: substitution of Ywith F, T with S or K, P with A, E with D or Q, N with D or G, R with K,G with N or A, T with S or K, D with N or E, I with L or V, F with Y, Swith T or A, R with K, G with N or A, K with R, A with S, K or P.

In alternative embodiments, one can also select conservative amino acidsubstitutions encompassed suitable for amino acids on the interior of aprotein or peptide, for example one can use suitable conservativesubstitutions for amino acids is on the interior of a protein or peptide(i.e. the amino acids are not exposed to a solvent), for example but notlimited to, one can use the following conservative substitutions: whereY is substituted with F, T with A or S, I with L or V, W with Y, M withL, N with D, G with A, T with A or S, D with N, I with L or V, F with Yor L, S with A or T and A with S, G, T or V. In some embodiments,non-conservative amino acid substitutions are also encompassed withinthe term of variants.

As used herein an “antibody” refers to IgG, IgM, IgA, IgD or IgEmolecules or antigen-specific antibody fragments thereof (including, butnot limited to, a Fab, F(ab′)₂, Fv, disulphide linked Fv, scFv, singledomain antibody, closed conformation multispecific antibody,disulphide-linked scfv, diabody), whether derived from any species thatnaturally produces an antibody, or created by recombinant DNAtechnology; whether isolated from serum, B-cells, hybridomas,transfectomas, yeast or bacteria. Antibodies can be humanized usingroutine technology.

As described herein, an “antigen” is a molecule that is bound by abinding site on an antibody agent. Typically, antigens are bound byantibody ligands and are capable of raising an antibody response invivo. An antigen can be a polypeptide, protein, nucleic acid or othermolecule or portion thereof. The term “antigenic determinant” refers toan epitope on the antigen recognized by an antigen-binding molecule, andmore particularly, by the antigen-binding site of said molecule.

As used herein, the term “antibody fragment” refers to a polypeptidethat includes at least one immunoglobulin variable domain orimmunoglobulin variable domain sequence and which specifically binds agiven antigen. An antibody fragment can comprise an antibody or apolypeptide comprising an antigen-binding domain of an antibody. In someembodiments, an antibody fragment can comprise a monoclonal antibody ora polypeptide comprising an antigen-binding domain of a monoclonalantibody. For example, an antibody can include a heavy (H) chainvariable region (abbreviated herein as VH), and a light (L) chainvariable region (abbreviated herein as VL). In another example, anantibody includes two heavy (H) chain variable regions and two light (L)chain variable regions. The term “antibody fragment” encompassesantigen-binding fragments of antibodies (e.g., single chain antibodies,Fab and sFab fragments, F(ab′)2, Fd fragments, Fv fragments, scFv, anddomain antibodies (dAb) fragments (see, e.g. de Wildt et al., Eur J.Immunol. 1996; 26(3):629-39; which is incorporated by reference hereinin its entirety)) as well as complete antibodies. An antibody can havethe structural features of IgA, IgG, IgE, IgD, IgM (as well as subtypesand combinations thereof). Antibodies can be from any source, includingmouse, rabbit, pig, rat, and primate (human and non-human primate) andprimatized antibodies. Antibodies also include midibodies, humanizedantibodies, chimeric antibodies, and the like.

As used herein, “antibody variable domain” refers to the portions of thelight and heavy chains of antibody molecules that include amino acidsequences of Complementarity Determining Regions (CDRs; ie., CDR1, CDR2,and CDR3), and Framework Regions (FRs). VH refers to the variable domainof the heavy chain. VL refers to the variable domain of the light chain.According to the methods used in this invention, the amino acidpositions assigned to CDRs and FRs may be defined according to Kabat(Sequences of Proteins of Immunological Interest (National Institutes ofHealth, Bethesda, Md., 1987 and 1991)) or according to IMGTnomenclature.

D domain or region refers to the diversity domain or region of anantibody chain. J domain or region refers to the joining domain orregion of an antibody chain.

An antibody “gene segment”, e.g. a VH gene segment, D gene segment, orJH gene segment refers to oligonucleotide having a nucleic acid sequencethat encodes that portion of an antibody, e.g. a VH gene segment is anoligonucleotide comprising a nucleic acid sequence that encodes apolypeptide VH domain.

The VH and VL regions can be further subdivided into regions ofhypervariability, termed “complementarity determining regions” (“CDR”),interspersed with regions that are more conserved, termed “frameworkregions” (“FR”). The extent of the framework region and CDRs has beenprecisely defined (see, IMGT or Kabat, E. A., et al. (1991) Sequences ofProteins of Immunological Interest, Fifth Edition, U.S. Department ofHealth and Human Services, NIH Publication No. 91-3242, and Chothia, C.et al. (1987) J. Mol. Biol. 196:901-917; which are incorporated byreference herein in their entireties). Each VH and VL is typicallycomposed of three CDRs and four FRs, arranged from amino-terminus tocarboxy-terminus in the following order: FR1, CDR1, FR2, CDR2, FR3,CDR3, FR4.

The terms “antigen-binding fragment” or “antigen-binding domain”, whichare used interchangeably herein are used to refer to one or morefragments of a full length antibody that retain the ability tospecifically bind to a target of interest. Examples of binding fragmentsencompassed within the term “antigen-binding fragment” of a full lengthantibody include (i) a Fab fragment, a monovalent fragment consisting ofthe VL, VH, CL and CH1 domains; (ii) a F(ab′)2 fragment, a bivalentfragment including two Fab fragments linked by a disulfide bridge at thehinge region; (iii) an Fd fragment consisting of the VH and CH1 domains;(iv) an Fv fragment consisting of the VL and VH domains of a single armof an antibody, (v) a dAb fragment (Ward et al., (1989) Nature341:544-546; which is incorporated by reference herein in its entirety),which consists of a VH or VL domain; and (vi) an isolatedcomplementarity determining region (CDR) that retains specificantigen-binding functionality.

As used herein, the term “antibody binding site” refers to a polypeptideor domain that comprises one or more CDRs of an antibody and is capableof binding an antigen. For example, the polypeptide comprises a CDR3(eg, HCDR3). For example the polypeptide comprises CDRs 1 and 2 (eg,HCDR1 and 2) or CDRs 1-3 of a variable domain of an antibody (eg,HCDRs1-3). In an example, the antibody binding site is provided by asingle variable domain (eg, a VH or VL domain). In another example, thebinding site comprises a VH/VL pair or two or more of such pairs.

As used herein, the term “specific binding” refers to a chemicalinteraction between two molecules, compounds, cells and/or particleswherein the first entity binds to the second, target entity with greaterspecificity and affinity than it binds to a third entity which is anon-target. For example, in an diagnostic test the specific binding of aligand can distinguish between two variant PCSK9 proteins as describedherein. In some embodiments, specific binding can refer to an affinityof the first entity for the second target entity which is at least 10times, at least 50 times, at least 100 times, at least 500 times, atleast 1000 times or greater than the affinity for the third nontargetentity. In the context of oligonucleotide strands which interact viahybridization, specific binding can be “specific hybridization.”

Additionally, and as described herein, a recombinant human(ized)antibody can be further optimized to decrease potential immunogenicity,while maintaining functional activity, for therapy in humans. In thisregard, functional activity means a polypeptide capable of displayingone or more known functional activities associated with a recombinantantibody or antibody reagent thereof as described herein. Suchfunctional activities include, e.g. the ability to bind to a targetmolecule.

The term “immunizing” refers to the step or steps of administering oneor more antigens to an animal so that antibodies can be raised in theanimal Generally, immunizing comprises injecting the antigen or antigensinto the animal Immunization can involve one or more administrations ofthe antigen or antigens. Suitable methods are prime-boost and RIMMSprocedures as known to the skilled person in the art.

As used herein, an “affibody” refers to a relatively small syntheticprotein molecule that has high binding affinity for a target protein(e.g. for PCSK9 or a variant thereof). Affibodies are composed of athree-helix bundle domain derived from the IgG-binding domain ofstaphylococcal protein A. The protein domain consists of a 58 amino acidsequence, with 13 randomized amino acids affording a range of affibodyvariants. Despite being significantly smaller than an antibody (anaffibody weighs about 6 kDa while an antibody commonly weighs about 150kDa), an affibody molecule works like an antibody since its binding siteis approximately equivalent in surface area to the binding site of anantibody.

As used herein, “VH3-23*04” refers to a human VH domain variantcomprising the polypeptide sequence of SEQ ID NO: 38. As opposed to thereference sequence, VH3-23*04 has a valine residue instead of a leucineresidue (see FIGS. 3 and 4; L24V, numbering including signal sequence;valine at position 5 shown in FIG. 4) as a result of the presence of thers56069819 SNP in the nucleic acid sequence encoding the VH domain. Asused herein, “rs56069819” refers to a mutation or variant in a VH genesegment from adenosine to cytosine (or thymine to guanine, dependingupon the strand of DNA which is being read), resulting in the VH domainencoding VH3-23*04. Rs56069819 is depicted in FIG. 4 and SEQ ID NO: 39,which demonstrate the T→G mutation (it is noted that the dbSNP entry forRS5606819 depicts the other strand, which comprises the A→C mutation).Further description of VH3-23*04 can be found, e.g., in US PatentPublication 2013/0071405; which is incorporated by reference herein inits entirety.

As used herein, “determine” or “determining” refers to ascertaining,e.g., by a quantitative or qualitative analysis. As used herein, “hasbeen determined” can refer to ascertaining on the basis of previouslyobtained information or simultaneously obtained information.

In some aspects of all embodiments of the invention selecting caninclude automation such as a computer implemented software program thatupon input of the relevant data such as ethnicity or a panel of SNP datacan make the determination based on the instructions set forth herein.

As used herein, “assaying” refers to assessing, evaluating, quantifying,measuring, or characterizing an analyte, e.g., measuring the level of ananalyte in a sample, identifying an analyte, or detecting the presenceor absence of an analyte in a sample. In some embodiments, assayingrefers to detecting a presence or absence of the analyte of interest. Insome embodiments, assaying refers to quantifying an amount of ananalyte, e.g., providing a measure of concentration or degree of analyteabundance. In some embodiments, assaying refers to enumerating thenumber of molecules of analyte present in a sample and/or specimen,e.g., to determine an analyte copy number.

As used herein “multiplex” refers to the carrying out of a method orprocess simultaneously and in the same reaction vessel on two or more,typically three or more, different target sequences, e.g. on two or moreisoforms of PCSK9, or PCSK9 and an additional target. A multiplexanalysis typically includes analysis of 10-50; 10-100; 10-1000, 10-5000,10-10000 reactions in a multiplex format, such as a multiwall, an array,or a multichannel reaction.

Often the analysis or multiplex analysis is also automated usingrobotics and typically software executed by a computer and may include arobotic handling of samples, automatic or robotic selection of positiveor negative results, assaying for presence of absence of a target, suchas a nucleic acid polymorphism or a protein variant.

The term “biological sample” or “test sample” as used herein denotes asample taken or isolated from a biological organism, e.g., a sample froma subject. Exemplary biological samples include, but are not limited to,a biofluid sample; serum; plasma; urine; saliva; hair, epithelial cells,skin, a tumor biopsy and/or tissue sample etc. The term also includes amixture of the above-mentioned samples. The term “test sample” or“biological sample” also includes untreated or pretreated (orpre-processed) biological samples. For the analysis of nucleic acids,the biological sample should typically comprise at least one cellcomprising nucleic acids.

The test sample can be obtained by removing a sample of cells from asubject, but can also be accomplished by using previously isolated cells(e.g. isolated at a prior time point and isolated by the same or anotherperson). In addition, the test sample can be freshly collected or apreviously collected, refrigerated, frozen or otherwise preservedsample.

In some embodiments, the test sample can be an untreated test sample. Asused herein, the phrase “untreated test sample” refers to a test samplethat has not had any prior sample pre-treatment except for dilutionand/or suspension in a solution. Exemplary methods for treating a testsample include, but are not limited to, centrifugation, filtration,sonication, homogenization, heating, freezing and thawing, andcombinations thereof. In some embodiments, the test sample can be afrozen test sample, e.g., a frozen tissue. The frozen sample can bethawed before employing methods, assays and systems described herein.After thawing, a frozen sample can be centrifuged before being subjectedto methods, assays and systems described herein. In some embodiments,the test sample is a clarified test sample, for example, bycentrifugation and collection of a supernatant comprising the clarifiedtest sample. In some embodiments, a test sample can be a pre-processedtest sample, for example, supernatant or filtrate resulting from atreatment selected from the group consisting of centrifugation,filtration, thawing, purification, and any combinations thereof. In someembodiments, the test sample can be treated with a chemical and/orbiological reagent. Chemical and/or biological reagents can be employedto protect and/or maintain the stability of the sample, includingbiomolecules (e.g., nucleic acid and protein) therein, duringprocessing. One exemplary reagent is a protease inhibitor, which isgenerally used to protect or maintain the stability of protein duringprocessing. The skilled artisan is well aware of methods and processesappropriate for pre-processing of biological samples required fordetermination of the level of an expression product as described herein.

As used herein, “genotyping” refers to a process of determining thespecific allelic composition of a cell and/or subject at one or moreposition within the genome, e.g. by determining the nucleic acidsequence at that position. Genotyping refers to a nucleic acid analysisand/or analysis at the nucleic acid level. As used herein, “phenotyping”refers a process of determining the identity and/or composition of anexpression product of a cell and/or subject, e.g. by determining thepolypeptide sequence of an expression product. Phenotyping refers to aprotein analysis and/or analysis at the protein level.

As used herein, the term “nucleic acid amplification” refers to theproduction of additional copies of a nucleic acid sequence and istypically carried out using polymerase chain reaction (PCR) or ligasechain reaction (LCR) technologies well known in the art (Dieffenbach, C.W. and G. S. Dveksler (1995) PCR Primer, a Laboratory Manual, ColdSpring Harbor Press, Plainview, N. Y.). Other methods for amplificationare also contemplated in aspects of the invention.

The term “allele-specific amplification” refers to a reaction (e.g., PCRreaction) in which at least one of the primers (e.g., allele-specificprimer) is chosen from a polymorphic area of gene (e.g., singlenucleotide polymorphism), with the polymorphism located at or near theprimer's 3′-end. A mismatched primer will not initiate amplification,whereas a matched primer will initiate amplification. The appearance ofan amplification product is indicative of the presence of thepolymorphism.

As used herein, “sequencing” refers to the determination of the exactorder of nucleotide bases in a strand of DNA (deoxyribonucleic acid) orRNA (ribonucleic acid) or the exact order of amino acids residues orpeptides in a protein. Nucleic acid sequencing can be done using Sangersequencing or next-generation high-throughput sequencing.

As used herein “next-generation sequencing” refers to oligonucleotidesequencing technologies that have the capacity to sequenceoligonucleotides at speeds above those possible with conventionalsequencing methods (e.g. Sanger sequencing), due to performing andreading out thousands to millions of sequencing reactions in parallel.Non-limiting examples of next-generation sequencing methods/platformsinclude Massively Parallel Signature Sequencing (Lynx Therapeutics); 454pyro-sequencing (454 Life Sciences/Roche Diagnostics); solid-phase,reversible dye-terminator sequencing (Solexa/Illumina); SOLiD technology(Applied Biosystems); Ion semiconductor sequencing (ION Torrent); DNAnanoball sequencing (Complete Genomics); and technologies available fromPacific Biosciences, Intelligen Bio-systems, Oxford NanoporeTechnologies, and Helicos Biosciences. Next-generation sequencingtechnologies and the constraints and design parameters of associatedsequencing primers are well known in the art (see, e.g. Shendure, etal., “Next-generation DNA sequencing,” Nature, 2008, vol. 26, No. 10,1135-1145; Mardis, “The impact of next-generation sequencing technologyon genetics,” Trends in Genetics, 2007, vol. 24, No. 3, pp. 133-141; Su,et al., “Next-generation sequencing and its applications in moleculardiagnostics” Expert Rev Mol Diagn, 2011, 11(3):333-43; Zhang et al.,“The impact of next-generation sequencing on genomics”, J GenetGenomics, 2011, 38(3):95-109; (Nyren, P. et al. Anal Biochem 208: 17175(1993); Bentley, D. R. Curr Opin Genet Dev 16:545-52 (2006); Strausberg,R. L., et al. Drug Disc Today 13:569-77 (2008); U.S. Pat. No. 7,282,337;U.S. Pat. No. 7,279,563; U.S. Pat. No. 7,226,720; U.S. Pat. No.7,220,549; U.S. Pat. No. 7,169,560; U.S. Pat. No. 6,818,395; U.S. Pat.No. 6,911,345; US Pub. Nos. 2006/0252077; 2007/0070349; and 20070070349;which are incorporated by reference herein in their entireties).

As used herein, “nucleic acid hybridization” refers to the pairing ofcomplementary RNA and DNA strands as well as the pairing ofcomplementary DNA single strands. In some embodiments, nucleic acidhybridization can refer to a method of determining a nucleic acidsequence and/or identity by hybridizing a nucleic acid sample with aprobe, e.g. Northern or Southern blot analysis or microarray analysis.

As used herein, the terms “treat” “treatment” “treating,” or“amelioration” refer to therapeutic treatments, wherein the object is toreverse, alleviate, ameliorate, inhibit, slow down or stop theprogression or severity of a condition associated with a disease ordisorder. The term “treating” includes reducing or alleviating at leastone adverse effect or symptom of a condition, disease or disorder.Treatment is generally “effective” if one or more symptoms or clinicalmarkers are reduced. Alternatively, treatment is “effective” if theprogression of a disease is reduced or halted. That is, “treatment”includes not just the improvement of symptoms or markers, but also acessation of, or at least slowing of, progress or worsening of symptomscompared to what would be expected in the absence of treatment.Beneficial or desired clinical results include, but are not limited to,alleviation of one or more symptom(s), diminishment of extent ofdisease, stabilized (i.e., not worsening) state of disease, delay orslowing of disease progression, amelioration or palliation of thedisease state, remission (whether partial or total), and/or decreasedmortality, whether detectable or undetectable. The term “treatment” of adisease also includes providing relief from the symptoms or side-effectsof the disease (including palliative treatment). For treatment to beeffective a complete cure is not contemplated. The method can in certainaspects include cure as well.

As used herein, the term “pharmaceutical composition” refers to theactive agent in combination with a pharmaceutically acceptable carriere.g. a carrier commonly used in the pharmaceutical industry. The phrase“pharmaceutically acceptable” is employed herein to refer to thosecompounds, materials, compositions, and/or dosage forms which are,within the scope of sound medical judgment, suitable for use in contactwith the tissues of human beings and animals without excessive toxicity,irritation, allergic response, or other problem or complication,commensurate with a reasonable benefit/risk ratio.

As used herein, the term “administering,” refers to the placement of acompound as disclosed herein into a subject by a method or route whichresults in at least partial delivery of the agent at a desired site.Pharmaceutical compositions comprising the compounds disclosed hereincan be administered by any appropriate route which results in aneffective treatment in the subject.

Multiple compositions can be administered separately or simultaneously.Separate administration refers to the two compositions beingadministered at different times, e.g. at least 10, 20, 30, or 10-60minutes apart, or 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 hours apart. One canalso administer compositions at 24 hours apart, or even longer apart.Alternatively, two or more compositions can be administeredsimultaneously, e.g. less than 10 or less than 5 minutes apart.Compositions administered simultaneously can, in some aspects, beadministered as a mixture, with or without similar or different timerelease mechanism for each of the components.

As used herein, “contacting” refers to any suitable means fordelivering, or exposing, an agent to at least one complex, enzyme, orcell. Exemplary delivery methods include, but are not limited to, directdelivery to cell culture medium, perfusion, injection, or other deliverymethod well known to one skilled in the art.

As used herein, “obtain” refers to any method of acquiring, securing,procuring, or coming into the possession of, e.g. a sample. Obtaining abiological sample from a subject can comprise physical removing a samplefrom a subject (e.g. drawing blood or taking a hair or saliva sample)without or without active participation from the subject; receiving asample from a subject (e.g. the subject collects a saliva or hair samplethemselves and provides it, e.g. in a container provided for thepurpose); or procuring a sample from a storage facility, medicalfacility, or medical provider. Obtain from the human or subject, refersto an active step of, e.g., drawing blood or taking a tissue or cellsample.

As used herein, “cholesterol level” refers to a level of one or more oftotal cholesterol, LDL cholesterol, HDL cholesterol, and/ortriglycerides. Cholesterol levels can be the level of cholesterol in theblood of a subject.

As used herein in reference to cholesterol levels, “maintain” refers topreventing the level from worsening (e.g. increasing). In someembodiments, maintaining a particular level refers to a process thatresults in the cholesterol level not increasing by more than 10% overtime. Maintaining may also refer to maintaining a previously achievedlevel. For example, if a human has received statin treatment, one canmaintain the cholesterol level achieved using the statin treatment.

In some embodiments, the subject treated according to the methodsdescribed herein has previously had their cholesterol level reduced. Asused herein, “previously reduced” indicates that at a prior point intime, the subject experienced a decrease in cholesterol levels. Thedecrease can be due to administration of a pharmaceutical composition(e.g. administration of a composition as described herein or anothercomposition, e.g. a statin) or due to another cause, e.g. a change indiet and/or exercise.

An existing treatment for high cholesterol levels is the administrationof a statin. As referred to herein, a “statin” (also known as HMG-CoAreductase inhibitors) are inhibitors of the enzyme HMG-coA reductase,which mediates cholesterol production in the liver. Statins, bycompetitively binding HMG-CoA reductase, prevent the binding of HMG-CoAto the enzyme and thereby inhibit the activity of the reductase (e.g.the production of mevalonate). Non-limiting examples of statins caninclude atorvastatin (LIPITOR™), fluvastatin (LESCOL™), lovastatin(MEVACOR™, ALTOCOR™), pitavastatin (LIVALO™), pravastatin (PRAVACHOL™)rosuvastatin (CRESTOR™), and simvastatin (ZOCOR™). Statins can beadministered in combination with other agents, e.g. the combination ofezetimibe and simvastatin.

Some subjects are, or become, resistant to statin treatment. As usedherein, “resistant to statin treatment” or “reduced responsiveness tostatin treatment” refers to a subject exhibiting a statisticallysignificantly lower response to the administration of a statin ascompared to a reference level. The reference level can be, e.g., theaverage response for a population of subjects or the level of theindividual subject at an earlier date. A response to statin treatment isreadily measured by one of skill in the art, e.g., measurement ofcholesterol levels, changes in cholesterol levels, and/or HMG-CoAreductase activity.

As used herein, the term “detectable label” refers to a molecule ormoiety that can be detected, e.g. measured and/or determined to bepresent or absent. Detectable labels can comprise, for example, alight-absorbing dye, a fluorescent dye, or a radioactive label.Detectable labels, methods of detecting them, and methods ofincorporating them into reagents (e.g. antibodies and nucleic acidprobes) are well known in the art.

In some embodiments, detectable labels can include labels that can bedetected by spectroscopic, photochemical, biochemical, immunochemical,electromagnetic, radiochemical, or chemical means, such as fluorescence,chemifluoresence, or chemiluminescence, or any other appropriate means.The detectable labels used in the methods described herein can beprimary labels (where the label comprises a moiety that is directlydetectable or that produces a directly detectable moiety) or secondarylabels (where the detectable label binds to another moiety to produce adetectable signal, e.g., as is common in immunological labeling usingsecondary and tertiary antibodies). The detectable label can be linkedby covalent or non-covalent means to the reagent. Alternatively, adetectable label can be linked such as by directly labeling a moleculethat achieves binding to the reagent via a ligand-receptor binding pairarrangement or other such specific recognition molecules. Detectablelabels can include, but are not limited to radioisotopes, bioluminescentcompounds, chromophores, antibodies, chemiluminescent compounds,fluorescent compounds, metal chelates, and enzymes.

In other embodiments, the detectable label can be a fluorescentcompound. When the fluorescently label is exposed to light of the properwavelength, its presence can then be detected due to fluorescence. Insome embodiments, a detectable label can be a fluorescent dye molecule,or fluorophore including, but not limited to fluorescein, phycoerythrin,phycocyanin, o-phthaldehyde, fluorescamine, Cy3™, Cy5™,allophycocyanine, Texas Red, peridenin chlorophyll, cyanine, tandemconjugates such as phycoerythrin-Cy5™, green fluorescent protein,rhodamine, fluorescein isothiocyanate (FITC) and Oregon Green™,rhodamine and derivatives (e.g., Texas red and tetrarhodimineisothiocynate (TRITC)), biotin, phycoerythrin, AMCA, CyDyes™,6-carboxyfhiorescein (commonly known by the abbreviations FAM and F),6-carboxy-2′,4′,7′,4,7-hexachlorofiuorescein (HEX),6-carboxy-4′,5′-dichloro-2′,7′-dimethoxyfluorescein (JOE or J),N,N,N′,N′-tetramethyl-6carboxyrhodamine (TAMRA or T),6-carboxy-X-rhodamine (ROX or R), 5-carboxyrhodamine-6G (R6G5 or G5),6-carboxyrhodamine-6G (R6G6 or G6), and rhodamine 110; cyanine dyes,e.g. Cy3, Cy5 and Cy7 dyes; coumarins, e.g umbelliferone; benzimidedyes, e.g. Hoechst 33258; phenanthridine dyes, e.g. Texas Red; ethidiumdyes; acridine dyes; carbazole dyes; phenoxazine dyes; porphyrin dyes;polymethine dyes, e.g. cyanine dyes such as Cy3, Cy5, etc; BODIPY dyesand quinoline dyes. In some embodiments, a detectable label can be aradiolabel including, but not limited to ³H, ¹²⁵I, ³⁵S, ¹⁴C, ³²P, and³³P. In some embodiments, a detectable label can be an enzyme including,but not limited to horseradish peroxidase and alkaline phosphatase. Anenzymatic label can produce, for example, a chemiluminescent signal, acolor signal, or a fluorescent signal. Enzymes contemplated for use as adetectable label can include, but are not limited to, malatedehydrogenase, staphylococcal nuclease, delta-V-steroid isomerase, yeastalcohol dehydrogenase, alpha-glycerophosphate dehydrogenase, triosephosphate isomerase, horseradish peroxidase, alkaline phosphatase,asparaginase, glucose oxidase, beta-galactosidase, ribonuclease, urease,catalase, glucose-VI-phosphate dehydrogenase, glucoamylase andacetylcholinesterase. In some embodiments, a detectable label is achemiluminescent label, including, but not limited to lucigenin,luminol, luciferin, isoluminol, theromatic acridinium ester, imidazole,acridinium salt and oxalate ester. In some embodiments, a detectablelabel can be a spectral colorimetric label including, but not limited tocolloidal gold or colored glass or plastic (e.g., polystyrene,polypropylene, and latex) beads.

In some embodiments, reagents can also be labeled with a detectable tag,such as c-Myc, HA, VSV-G, HSV, FLAG, V5, HIS, or biotin. Other detectionsystems can also be used, for example, a biotin-streptavidin system. Inthis system, the antibodies immunoreactive (i. e. specific for) with thebiomarker of interest is biotinylated. Quantity of biotinylated antibodybound to the biomarker is determined using a streptavidin-peroxidaseconjugate and a chromagenic substrate. Such streptavidin peroxidasedetection kits are commercially available, e. g. from DAKO; Carpinteria,Calif. A reagent can also be detectably labeled using fluorescenceemitting metals such as ¹⁵²Eu, or others of the lanthanide series. Thesemetals can be attached to the reagent using such metal chelating groupsas diethylenetriaminepentaacetic acid (DTPA) orethylenediaminetetraacetic acid (EDTA).

As used herein, “authorization number” or “marketing authorizationnumber” refers to a number issued by a regulatory agency upon thatagency determining that a particular medical product and/or compositionmay be marketed and/or offered for sale in the area under the agency'sjurisdiction. As used herein “regulatory agency” refers to one of theagencies responsible for evaluating, e.g, the safety and efficacy of amedical product and/or composition and controlling the sales/marketingof such products and/or compositions in a given area. The Food and DrugAdministration (FDA) in the US and the European Medicines Agency (EPA)in Europe are but two examples of such regulatory agencies. Othernon-limiting examples can include SDA, MPA, MHPRA, IMA, ANMAT, Hong KongDepartment of Health-Drug Office, CDSCO, Medsafe, and KFDA.

As used herein, “injection device” refers to a device that is designedfor carrying out injections, an injection including the steps oftemporarily fluidically coupling the injection device to a person'stissue, typically the subcutaneous tissue. An injection further includesadministering an amount of liquid drug into the tissue and decoupling orremoving the injection device from the tissue. In some embodiments, aninjection device can be an intravenous device or IV device, which is atype of injection device used when the target tissue is the blood withinthe circulatory system, e.g., the blood in a vein. A common, butnon-limiting example of an injection device is a needle and syringe.

As used herein, a “buffer” refers to a chemical agent that is able toabsorb a certain quantity of acid or base without undergoing a strongvariation in pH.

As used herein, “packaging” refers to how the components are organizedand/or restrained into a unit fit for distribution and/or use. Packagingcan include, e.g., boxes, bags, syringes, ampoules, vials, tubes,clamshell packaging, barriers and/or containers to maintain sterility,labeling, etc.

As used herein, “instructions” refers to a display of written, printedor graphic matter on the immediate container of an article, for examplethe written material displayed on a vial containing a pharmaceuticallyactive agent, or details on the composition and use of a product ofinterest included in a kit containing a composition of interest.Instructions set forth the method of the treatment as contemplated to beadministered or performed.

As used herein, a “solid surface” refers to an object suitable for theattachment of biomolecules. Non-limiting examples of a solid surface caninclude a particle (including, but not limited to an agarose or latexbead or particle or a magnetic particle), a bead, a nanoparticle, apolymer, a substrate, a slide, a coverslip, a plate, a dish, a well, amembrane, and/or a grating. The solid surface can include many differentmaterials including, but not limited to, polymers, plastics, resins,polysaccharides, silicon or silica based materials, carbon, metals,inorganic glasses, and membranes.

As used herein, “classification” of a subject, e.g., classification ofthe subject's ancestry refers to determining if the subject hasbiological ancestors who originated in a particular geographical area,and are therefore likely to have particular genetic variants found inthe populations which have historically occupied that area.Classification can comprise, e.g. obtaining information on the subject'sfamily, interviewing the subject or a family member regarding theirbiological family's ancestry, and/or genetic testing. Classification canbe on the basis used for the 1000 Genomes Project, as will be familiarto the skilled person in the art. In some embodiments, the subject canbe classified as being of a particular ancestry if at least thesubject's genome comprises a substantial number of different alleles incommon with other humans of that ancestry (eg, determined by referenceto the 1000 Genomes Project database), for example, at least 10, 20, 30,40, 50 or 100 or more alleles in common Abbreviations for particularancestral groups are provided in Table 4.

The term “statistically significant” or “significantly” refers tostatistical significance and generally means a two standard deviation(2SD) or greater difference.

Other than in the operating examples, or where otherwise indicated, allnumbers expressing quantities of ingredients or reaction conditions usedherein should be understood as modified in all instances by the term“about.” The term “about” when used in connection with percentages canmean±1%.

As used herein the term “comprising” or “comprises” is used in referenceto compositions, methods, and respective component(s) thereof, that areessential to the method or composition, yet open to the inclusion ofunspecified elements, whether essential or not.

The term “consisting of” refers to compositions, methods, and respectivecomponents thereof as described herein, which are exclusive of anyelement not recited in that description of the embodiment.

As used herein the term “consisting essentially of” refers to thoseelements required for a given embodiment. The term permits the presenceof elements that do not materially affect the basic and novel orfunctional characteristic(s) of that embodiment.

The singular terms “a,” “an,” and “the” include plural referents unlesscontext clearly indicates otherwise. Similarly, the word “or” isintended to include “and” unless the context clearly indicatesotherwise. Although methods and materials similar or equivalent to thosedescribed herein can be used in the practice or testing of thisdisclosure, suitable methods and materials are described below. Theabbreviation, “e.g.” is derived from the Latin exempli gratia, and isused herein to indicate a non-limiting example. Thus, the abbreviation“e.g.” is synonymous with the term “for example.”

Definitions of common terms in cell biology and molecular biology can befound in “The Merck Manual of Diagnosis and Therapy”, 19th Edition,published by Merck Research Laboratories, 2006 (ISBN 0-911910-19-0);Robert S. Porter et al. (eds.), The Encyclopedia of Molecular Biology,published by Blackwell Science Ltd., 1994 (ISBN 0-632-02182-9); BenjaminLewin, Genes X, published by Jones & Bartlett Publishing, 2009 (ISBN-10:0763766321); Kendrew et al. (eds.), Molecular Biology and Biotechnology:a Comprehensive Desk Reference, published by VCH Publishers, Inc., 1995(ISBN 1-56081-569-8) and Current Protocols in Protein Sciences 2009,Wiley Intersciences, Coligan et al., eds.

Unless otherwise stated, the present invention was performed usingstandard procedures, as described, for example in Sambrook et al.,Molecular Cloning: A Laboratory Manual (4 ed.), Cold Spring HarborLaboratory Press, Cold Spring Harbor, N.Y., USA (2012); Davis et al.,Basic Methods in Molecular Biology, Elsevier Science Publishing, Inc.,New York, USA (1995); or Methods in Enzymology: Guide to MolecularCloning Techniques Vol. 152, S. L. Berger and A. R. Kimmel Eds.,Academic Press Inc., San Diego, USA (1987); Current Protocols in ProteinScience (CPPS) (John E. Coligan, et. al., ed., John Wiley and Sons,Inc.), Current Protocols in Cell Biology (CPCB) (Juan S. Bonifacino et.al. ed., John Wiley and Sons, Inc.), and Culture of Animal Cells: AManual of Basic Technique by R. Ian Freshney, Publisher: Wiley-Liss; 5thedition (2005), Animal Cell Culture Methods (Methods in Cell Biology,Vol. 57, Jennie P. Mather and David Barnes editors, Academic Press, 1stedition, 1998) which are all incorporated by reference herein in theirentireties.

Other terms are defined herein within the description of the variousaspects of the invention.

All patents and other publications; including literature references,issued patents, published patent applications, and co-pending patentapplications; cited throughout this application are expresslyincorporated herein by reference for the purpose of describing anddisclosing, for example, the methodologies described in suchpublications that might be used in connection with the technologydescribed herein. These publications are provided solely for theirdisclosure prior to the filing date of the present application. Nothingin this regard should be construed as an admission that the inventorsare not entitled to antedate such disclosure by virtue of priorinvention or for any other reason. All statements as to the date orrepresentation as to the contents of these documents is based on theinformation available to the applicants and does not constitute anyadmission as to the correctness of the dates or contents of thesedocuments.

The description of embodiments of the disclosure is not intended to beexhaustive or to limit the disclosure to the precise form disclosed.While specific embodiments of, and examples for, the disclosure aredescribed herein for illustrative purposes, various equivalentmodifications are possible within the scope of the disclosure, as thoseskilled in the relevant art will recognize. For example, while methodsteps or functions are presented in a given order, alternativeembodiments may perform functions in a different order, or functions maybe performed substantially concurrently. The teachings of the disclosureprovided herein can be applied to other procedures or methods asappropriate. The various embodiments described herein can be combined toprovide further embodiments. Aspects of the disclosure can be modified,if necessary, to employ the compositions, functions and concepts of theabove references and application to provide yet further embodiments ofthe disclosure. Moreover, due to biological functional equivalencyconsiderations, some changes can be made in protein structure withoutaffecting the biological or chemical action in kind or amount. These andother changes can be made to the disclosure in light of the detaileddescription. All such modifications are intended to be included withinthe scope of the appended claims.

Specific elements of any of the foregoing embodiments can be combined orsubstituted for elements in other embodiments. Furthermore, whileadvantages associated with certain embodiments of the disclosure havebeen described in the context of these embodiments, other embodimentsmay also exhibit such advantages, and not all embodiments neednecessarily exhibit such advantages to fall within the scope of thedisclosure.

It will be understood that particular configurations, aspects, examples,clauses and embodiments described herein are shown by way ofillustration and not as limitations of the invention. The principalfeatures of this invention can be employed in various embodimentswithout departing from the scope of the invention. Those skilled in theart will recognize, or be able to ascertain using no more than routinestudy, numerous equivalents to the specific procedures described herein.Such equivalents are considered to be within the scope of this inventionand are covered by the claims. All publications and patent applicationsmentioned in the specification are indicative of the level of skill ofthose skilled in the art to which this invention pertains. Allpublications and patent applications are herein incorporated byreference to the same extent as if each individual publication or patentapplication was specifically and individually indicated to beincorporated by reference. The use of the word “a” or “an” when used inconjunction with the term “comprising” in the claims and/or thespecification may mean “one,” but it is also consistent with the meaningof “one or more,” “at least one,” and “one or more than one.” The use ofthe term “or” in the claims is used to mean “and/or” unless explicitlyindicated to refer to alternatives only or the alternatives are mutuallyexclusive, although the disclosure supports a definition that refers toonly alternatives and “and/or.” Throughout this application, the term“about” is used to indicate that a value includes the inherent variationof error for the device, the method being employed to determine thevalue, or the variation that exists among the study subjects.

As used in this specification and claim(s), the words “comprising” (andany form of comprising, such as “comprise” and “comprises”), “having”(and any form of having, such as “have” and “has”), “including” (and anyform of including, such as “includes” and “include”) or “containing”(and any form of containing, such as “contains” and “contain”) areinclusive or open-ended and do not exclude additional, unrecitedelements or method steps

Any part of this disclosure may be read in combination with any otherpart of the disclosure, unless otherwise apparent from the context.

References to sequences by “SEQ ID NO:” herein (eg, in the claims) is byreference to the sequences appearing in the Tables; similarly referenceto position numbers “in SEQ ID NO:” (eg, in the claims) is by referenceto the sequences appearing in the Tables herein (eg, as per Tables 6, 10and 17). Thus, for example, “an Asp corresponding to position 204 of SEQID NO: 42 or a Leu corresponding to position 206 of SEQ ID NO: 42”refers to the Asp and Leu labelled as being at positions 204 and 206respectively of SEQ ID NO: 42 shown in Table 10 herein.

All of the compositions and/or methods disclosed and claimed herein canbe made and executed without undue experimentation in light of thepresent disclosure. While the compositions and methods of this inventionhave been described in terms of preferred embodiments, it will beapparent to those of skill in the art that variations may be applied tothe compositions and/or methods and in the steps or in the sequence ofsteps of the method described herein without departing from the concept,spirit and scope of the invention. All such similar substitutes andmodifications apparent to those skilled in the art are deemed to bewithin the spirit, scope and concept of the invention as defined by theappended claims.

The present invention is described in more detail in the following nonlimiting Examples.

Some embodiments of the technology described herein can be definedaccording to any of the following numbered paragraphs:

-   1. A method of treating or preventing a disease or condition in a    human, wherein the disease or condition is mediated by a Target of    Interest (TOI), wherein the TOI is present in humans as different    polymorphic variants, the method comprising    -   a. selecting a human that is positive for the TOI polymorphic        variant, wherein the TOI in said human is encoded by a        nucleotide sequence comprising an allele having a cumulative        human allele frequency of less than 50% and/or wherein the TOI        in said human is encoded by a nucleotide sequence comprising an        allele having total human genotype frequency of less than 50%;        and    -   b. administering to the human an anti-TOI ligand to target the        TOI in the human to treat or prevent said disease or condition.        In a first alternative, paragraph 1 provides:—        A method of treating or preventing a disease or condition in a        human, wherein the disease or condition is mediated by a Target        of Interest (TOI), wherein the TOI is present in humans as        different polymorphic variants, the method comprising comprising        administering to said human an anti-TOI ligand (eg, an antibody        or antibody fragment) that specifically binds a TOI variant that        is encoded by a nucleotide sequence comprising a SNP having a        cumulative human allele frequency of less than 50% (eg, less        than 40, 35, 30, 35, 20, 15, 10, 5, 4, 3, 2, or 1%) and/or        wherein the TOI variant is encoded by a nucleotide sequence        comprising a SNP having total human genotype frequency of less        than 50% (eg, less than 40, 35, 30, 35, 20, 15, 10, 5, 4, 3, 2,        or 1%); wherein the human comprises a (eg, said) TOI-encoding        nucleotide sequence comprising said SNP; wherein        (i) the ligand (eg, antibody or fragment) comprises a VH domain        derived from the recombination of a human VH segment, a human D        gene segment and a human JH segment, the human VH segment        comprising a SNP, and wherein the human comprises a (eg, said)        VH segment comprising said SNP; or        (ii) the ligand (eg, antibody or fragment) comprises a Vλ domain        derived from the recombination of a human Vλ segment and a        human R. segment, the human Vλ segment comprising a SNP, and        wherein the human comprises a (eg, said) Vλ segment comprising        said SNP; or        (iii) the ligand (eg, antibody or fragment) comprises a Vκ        domain derived from the recombination of a human Vκ segment and        a human Jκ segment, the human Vκ segment comprising a SNP, and        wherein the human comprises a (eg, said) Vκ segment comprising        said SNP; or        (iv) the ligand (eg, antibody or fragment) comprises a heavy        chain constant region (eg, a gamma-1, 2, 3 o 4 constant region)        encoded by a nucleotide sequence comprising a SNP, and wherein        the human comprises a (eg, said) heavy chain constant region        (eg, a gamma-1, 2, 3 o 4 constant region respectively)        comprising said SNP; or        (v) the ligand (eg, antibody or fragment) comprises a lambda        chain constant encoded by a nucleotide sequence comprising a        SNP, and wherein the human comprises a (eg, said) lambda chain        constant region comprising said SNP; or        (vi) the ligand (eg, antibody or fragment) comprises a kappa        chain constant encoded by a nucleotide sequence comprising a        SNP, and wherein the human comprises a (eg, said) kappa chain        constant region comprising said SNP.

In a second alternative, paragraph 1 provides:—

A method of treating or preventing a disease or condition in a human,wherein the disease or condition is mediated by a Target of Interest(TOI), wherein the TOI is present in humans as different polymorphicvariants, the method comprising comprising administering to said humanan anti-TOI ligand (eg, an antibody or antibody fragment) thatspecifically binds a TOI variant that comprises a single amino acidvariation (ie, a single amino acid at a position where there isdifference between TOI variants in humans) having a cumulative humanallele frequency of less than 50% (eg, less than 40, 35, 30, 35, 20, 15,10, 5, 4, 3, 2, or 1%) and/or wherein the amino acid variant has a totalhuman genotype frequency of less than 50% (eg, less than 40, 35, 30, 35,20, 15, 10, 5, 4, 3, 2, or 1%); wherein the human expresses TOI proteinscomprising said single amino acid variation; wherein(i) the ligand (eg, antibody or fragment) comprises a VH domaincomprising the same single amino acid variation, and wherein the humanexpresses VH domains comprising said single amino acid variation; or(ii) the ligand (eg, antibody or fragment) comprises a Vλ domaincomprising a single amino acid variation, and wherein the humanexpresses Vλ domains comprising the same single amino acid variation; or(iii) the ligand (eg, antibody or fragment) comprises a Vκ domaincomprising a single amino acid variation, and wherein the humanexpresses Vκ domains comprising the same single amino acid variation; or(iv) the ligand (eg, antibody or fragment) comprises a heavy chainconstant region (eg, a gamma-1, 2, 3 o 4 constant region, eg, whereinthe constant region is an Fc, CH1, CH2 or CH3) comprising a single aminoacid variation, and wherein the human expresses a heavy chain constantregion (eg, a gamma-1, 2, 3 o 4 constant region, eg, wherein theconstant region is an Fc, CH1, CH2 or CH3 respectively) comprising thesame single amino acid variation; or(v) the ligand (eg, antibody or fragment) comprises a lambda chainconstant region comprising a single amino acid variation, and whereinthe human expresses a lambda chain constant region comprising the samesingle amino acid variation; or(vi) the ligand (eg, antibody or fragment) comprises a kappa chainconstant region comprising a single amino acid variation, and whereinthe human expresses a kappa chain constant region comprising the samesingle amino acid variation.The term “comprises a single amino acid variation” includes thepossibility of there being further amino acid variations in the TOIsequence.In an example, frequencies herein are according to the 1000 Genomesdatabase, eg, the Phase I database or as shown in Ensemble (available onthe world wide web at ensembl.org), eg, at 1^(st) October 2013 or 1^(st)October 2014.In an example, each SNP encodes a non-synonymous amino acid variation,ie, the SNP is not a silent mutation.

Optionally, the method comprises selecting said human comprising thenucleotide sequence prior to administration.

In a third alternative where the TOI is human PCSK9, paragraph 1provides:—

A method of reducing cholesterol level or maintaining previously reducedcholesterol level in a human in need thereof, the method comprisingadministering to said human an antibody or antibody fragment thatspecifically binds a proprotein convertase subtilisin/kexin type 9(PCSK9) that comprises a C-terminal domain comprising a mutation asdefined herein (eg, I474V or E670G) in SEQ ID NO: 1, wherein theantibody comprises a VH domain derived from the recombination of a humanVH segment, a human D gene segment and a human JH segment, the human VHsegment encoding a valine at the amino acid corresponding to position 5of SEQ ID NO: 40 and wherein said human comprises (i) a VH gene segmentencoding the framework 1 of SEQ ID NO: 40 and (ii) a nucleotide sequenceencoding a proprotein convertase subtilisin/kexin type 9 (PCSK9) thatcomprises a C-terminal domain comprising said mutation in SEQ ID NO: 1.In a fourth alternative where the TOI is human PCSK9, paragraph 1provides:—A method of reducing cholesterol level or maintaining previously reducedcholesterol level in a human in need thereof, the method comprisingadministering to said human an antibody or antibody fragment thatspecifically binds a proprotein convertase subtilisin/kexin type 9(PCSK9) that comprises a C-terminal domain comprising a mutation asdefined herein (eg, I474V or E670G) in SEQ ID NO: 1, wherein theantibody comprises a VL domain derived from the recombination of a humanVL segment and a human JL segment, the human VL segment is a Vλ or Vκdisclosed herein and wherein said human comprises (i) said VL genesegment and (ii) a nucleotide sequence encoding a proprotein convertasesubtilisin/kexin type 9 (PCSK9) that comprises a C-terminal domaincomprising said mutation in SEQ ID NO: 1.In a fifth alternative where the TOI is human PCSK9, paragraph 1provides:—A method of reducing cholesterol level or maintaining previously reducedcholesterol level in a human in need thereof, the method comprisingadministering to said human an antibody or antibody fragment thatspecifically binds a proprotein convertase subtilisin/kexin type 9(PCSK9) that comprises a C-terminal domain comprising a mutation asdefined herein (eg, I474V or E670G) in SEQ ID NO: 1, wherein theantibody comprises a C domain encoded by a human CH, Cλ or Cκ genesegment disclosed herein and wherein said human comprises (i) said Cgene segment and (ii) a nucleotide sequence encoding a proproteinconvertase subtilisin/kexin type 9 (PCSK9) that comprises a C-terminaldomain comprising said mutation in SEQ ID NO: 1.The following paragraphs 2-8, 19 and 49 onwards relate to any of thealternatives of paragraph 1.

-   2. The method of paragraph 1, wherein before step (a) the ligand has    been or is determined as being capable of specifically binding to    said TOI variant.-   3. The method of paragraph 1 or 2, comprising determining that the    human is positive for the TOI polymorphic variant, optionally    wherein the step of determining comprises determining that the human    is positive for a nucleotide variant encoding said TOI variant.-   4. The method of paragraph 3, wherein the step of determining    comprises assaying a biological sample obtained from said human for    a nucleotide polymorphism encoding said TOI polymorphic variant.-   5. The method of paragraph 3 or 4, wherein the step of determining    comprises assaying a biological sample obtained from said human for    a protein corresponding to the TOI polymorphic variant.-   6. The method of any preceding paragraph, wherein said frequency is    less than 15%.-   7. The method of any preceding paragraph, wherein said frequency is    less than 10%.-   8. The method of any preceding paragraph, wherein the ligand is    capable of specifically binding to two or more different TOI    variants, each being encoded by a nucleotide sequence comprising an    allele having a cumulative human allele frequency of less than 50%    and/or having a total human genotype frequency of less than 50%.-   9. A method of treating or preventing a disease or condition in a    human, wherein the disease or condition is mediated by a Target of    Interest (TOI), wherein the TOI is present in humans as different    polymorphic variants, the method comprising    -   a. selecting a human that is negative for a variant nucleotide        sequence comprising an allele having a cumulative human allele        frequency of less than 50% and/or having a total human genotype        frequency of less than 50%; or that the human is negative for a        TOI variant encoded by a nucleotide sequence comprising the        allele having a cumulative human allele frequency of less than        50% and/or having a total human genotype frequency of less than        50%; and    -   b. administering to the human an anti-TOI ligand to target the        TOI variant in the human and treat or prevent said disease or        condition, wherein the TOI in said human is a variant encoded by        a nucleotide sequence comprising an allele having a cumulative        human allele frequency of more than 50% and/or having a total        human genotype frequency of more than 50%.-   10. The method of paragraph 9, comprising determining that the human    is positive for the TOI polymorphic variant, optionally wherein the    determining comprises that the human has been or is phenotyped as    positive for the most frequent TOI variant or genotyped for the    nucleotide sequence thereof.-   11. The method of paragraph 10, wherein determining comprises    assaying for the nucleotide sequence to determine the presence of    said allele.-   12. The method of paragraph 11, wherein the assaying comprises    nucleic acid amplification.-   13. The method of paragraph 11 or 12, wherein the assaying comprises    hybridization, sequencing, or next generation sequencing.-   14. The method of any of paragraphs 11-13, further comprising the    step of obtaining a biological sample from the human.-   15. The method of any one of paragraphs 9-14, wherein the ligand has    been or is determined as being capable of specifically binding to    the most frequent TOI variant.-   16. The method of any one of paragraphs 9-15, wherein the ligand has    been or is determined as being substantially incapable of    neutralising or inhibiting said TOI variant.-   17. The method of any one of paragraphs 9-16, wherein the ligand is    capable of specifically binding to the most frequent TOI variant.-   18. The method of any one of paragraphs 9-17, wherein the ligand is    capable of specifically binding to two or more different TOI    variants, each being encoded by a nucleotide sequence comprising an    allele having a cumulative human allele frequency of more than 50%.-   19. The method of any preceding paragraph, wherein said TOI    polymorphic variant has been or is determined as being present in at    least two different human ethnic populations.-   20. The method of any preceding paragraph, wherein said cumulative    human allele frequency is the frequency in a database of    naturally-occurring sequences sampled from at least 15 different    human ethnic populations and comprising at least 1000 sequences.-   21. The method of any of the preceding paragraphs, wherein the    ligand is an antibody, antibody fragment or an affibody.-   22. The method of any of the preceding paragraphs, wherein the    ligand comprises a nucleotide sequence that specifically hybridises    to a TOI nucleotide sequence comprising an allele having a    cumulative human allele frequency of less than 50% and/or having a    total human genotype frequency of less than 50% or an RNA transcript    thereof; and/or the ligand comprises a nucleotide sequence that    comprises at least 10 contiguous nucleotides of a nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or having a total human genotype frequency of less than 50% or    is an antisense sequence thereof.-   23. The method of any of the preceding paragraphs, wherein the    genome of said human comprises an allele having a cumulative human    allele frequency of less than 50% and the allele is found in at    least 2 different ethnic populations.-   24. A composition comprising a ligand capable of binding a target of    interest encoded by a nucleotide sequence comprising an allele    having a cumulative human allele frequency of less than 50% and the    allele is found in at least 2 different ethnic populations and    optionally a pharmaceutically acceptable carrier and optionally a    label or instructions for use to treat and/or prevent said disease    or condition in a human; optionally wherein the label or    instructions comprise a marketing authorisation number issued by a    regulatory authority.-   25. A kit for treating or preventing a condition or disease mediated    by a target of interest as recited in any preceding paragraph, the    kit comprising a ligand capable of specifically binding a target of    interest encoded by a nucleotide sequence comprising an allele    having a cumulative human allele frequency of less than 50% and the    allele is found in at least 2 different ethnic populations; and    optionally in combination with a label or instructions for use to    treat and/or prevent said disease or condition in a human;    optionally wherein the label or instructions comprise a marketing    authorisation number issued by a regulatory agency; optionally    wherein the kit comprises an injection pen or IV container that    comprises the ligand.-   26. The composition of paragraph 24 or the kit of paragraph 25,    wherein the regulatory agency is FDA or EMA.-   27. A method of producing an anti-human TOI antibody binding site,    the method comprising obtaining a plurality of anti-TOI antibody    binding sites, screening the antibody binding sites for binding to a    TOI comprising an amino acid sequence encoded by a nucleotide    sequence comprising an allele having a cumulative human allele    frequency of less than 50% and/or a total human genotype frequency    of less than 50%, or to a peptide thereof that comprises an amino    acid variation from the corresponding sequence encoded by the    TOI-encoding nucleotide sequence comprising an allele having the    highest cumulative human allele frequency and/or the highest total    human genotype frequency, and isolating an antibody binding site    that binds in the screening step.-   28. A method of producing an anti-human TOI antibody, the method    comprising immunising a non-human vertebrate with a TOI comprising    an amino acid sequence encoded by a nucleotide sequence comprising    an allele having a cumulative human allele frequency of less than    50% and/or a total human genotype frequency of less than 50%, or to    a peptide thereof that comprises an amino acid variation from the    corresponding sequence encoded by the TOI-encoding nucleotide    sequence comprising an allele having the highest cumulative human    allele frequency and/or the highest total human genotype frequency,    and isolating an antibody that binds a TOI comprising an amino acid    sequence encoded by a TOI nucleotide sequence comprising an allele    having a cumulative human allele frequency of less than 50% and/or a    total human genotype frequency of less than 50%, and optionally    producing a TOI-binding fragment or derivative of the isolated    antibody.-   29. The method of paragraph 28, wherein the non-human vertebrate is    a mouse or a rat.-   30. The method of paragraph 29 or 30, comprising the step of    obtaining a nucleic acid encoding the antibody, fragment, derivative    or binding site and optionally inserting the nucleic acid in an    expression vector.-   31. A kit for TOI genotyping a human, wherein the kit comprises a    nucleic acid comprising a nucleotide sequence that specifically    hybridises to a TOI nucleotide sequence selected having a cumulative    human allele frequency of less than 50% and/or a total human    genotype frequency of less than 50% or an RNA transcript thereof    and/or the nucleic acid comprises a nucleotide sequence that    comprises at least 10 contiguous nucleotides of a TOI nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or a total human genotype frequency of less than 50% or is an    antisense sequence thereof.-   32. A kit for TOI genotyping or phenotyping a human, wherein the kit    comprises a ligand capable of binding a target of interest encoded    by a nucleotide sequence comprising an allele having a cumulative    human allele frequency of less than 50% or an antibody, fragment or    derivative produced by the method of any one of paragraphs 28 to 30.-   33. The kit of paragraph 32, wherein the allele is found in at least    2 different ethnic populations.-   34. Use of an anti-TOI ligand that specifically binds a human TOI    comprising an amino acid sequence encoded by a TOI nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or a total human genotype frequency of less than 50%, in the    manufacture of a medicament for treating and/or preventing a    TOI-mediated disease or condition in a human whose genome comprises    a TOI nucleotide sequence having a cumulative human allele frequency    of less than 50% and/or having a total human genotype frequency of    less than 50%.-   35. Use of an anti-TOI ligand that specifically binds a human TOI    comprising an amino acid sequence encoded by a TOI nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or a total human genotype frequency of less than 50%, in the    manufacture of a medicament for targeting said TOI in a human to    treat and/or prevent a disease or condition mediated by TOI.-   36. A method of targeting a Target of Interest (TOI) for treating    and/or preventing a TOI-mediated disease or condition in a human,    the method comprising administering an anti-TOI ligand to a human    comprising a TOI nucleotide sequence comprising an allele selected    as having a cumulative human allele frequency of less than 50%    and/or a total human genotype frequency of less than 50%, whereby a    TOI encoded by said nucleotide sequence is targeted.-   37. The method of paragraph 36, wherein the method comprises    targeting a human TOI comprising an amino acid sequence with said    ligand to treat and/or prevent said disease or condition in said    human, wherein said amino acid sequence is encoded by a nucleotide    sequence comprising an allele having a cumulative human allele    frequency of less than 50% and/or a total human genotype frequency    of less than 50%.-   38. A method of Target of Interest (TOI) genotyping a nucleic acid    sample of a human, the method comprising assaying in the sample the    presence of a TOI nucleotide sequence comprising an allele having a    cumulative human allele frequency of less than 50% and/or having a    total human genotype frequency of less than 50%.-   39. A method of Target of Interest (TOI) typing a protein sample of    a human, the method comprising assaying the sample the presence of a    TOI amino acid sequence encoded by a TOI nucleotide sequence    comprising an allele having a cumulative human allele frequency of    less than 50% and/or having a total human genotype frequency of less    than 50%.-   40. The method of paragraph 38 or 39, comprising obtaining a sample    of serum, blood, faeces, hair, urine or saliva from a human, whereby    the nucleic acid or protein sample is obtained for use in the step    of assaying said sequence.-   41. The method of any one of paragraphs 38-40, comprising using a    ligand capable of targeting a nucleic acid sequence comprising an    allele having a cumulative human allele frequency of less than 50%    and/or having a total human genotype frequency of less than 50% or a    ligand capable of specifically binding the TOI encoded by said    nucleic acid sequence to carry out said identifying step.-   42. A diagnostic kit comprising a ligand that is capable of binding    a human Target of Interest (TOI) comprising an amino acid sequence    encoded by a TOI nucleotide sequence comprising an allele having a    cumulative human allele frequency of less than 50% and/or a total    human genotype frequency of less than 50% and instructions for    carrying out the method of any one of paragraphs 38-41.-   43. The diagnostic kit wherein the ligand is selected from an    antibody, antibody fragment, antibody portion, affybody,    oligonucleotide, modified oligonucleotide, antisense    oligonucleotide, siRNA, and microRNA.-   44. A diagnostic kit comprising a nucleic acid probe comprising a    nucleotide sequence that specifically hybridises a Target of    Interest (TOI) nucleotide sequence comprising an allele having a    cumulative human allele frequency of less than 50% and/or a total    human genotype frequency of less than 50% or an RNA transcript    thereof and instructions for carrying out the method of paragraph 38    or 39.-   45. The method, ligand, composition, kit or use of any preceding    paragraph, wherein the TOI is encoded by a nucleotide sequence    having a cumulative human allele frequency from 1 to 10% and/or a    total human genotype frequency from 1 to about 15% or from 1 to 15%.-   46. The method, ligand, composition, kit or use of any preceding    paragraph wherein the TOI is a human TOI selected from Table 5;    optionally for treating and/or preventing a corresponding disease or    condition as set out in Table 5.-   47. A method of treating or preventing a disease or condition in a    human, wherein the disease or condition is mediated by a Target of    Interest (TOI), wherein the TOI is present in humans as different    polymorphic variants, the method comprising administering to the    human determined to be positive for the TOI polymorphic variant,    wherein the TOI in said human is encoded by a nucleotide sequence    comprising an allele having a cumulative human allele frequency of    less than 50% and/or wherein the TOI in said human is encoded by a    nucleotide sequence comprising an allele having total human genotype    frequency of less than 50% an anti-TOI ligand to target the TOI in    the human to treat or prevent said disease or condition.-   48. The method of paragraph 47, wherein the anti-TOI ligand is    selected from an antibody, an antibody portion, an antibody    fragment, an affibody, an antisense oligonucleotide, an siRNA, and a    microRNA.-   49. An anti-TOI ligand that specifically binds to a TOI as defined    in paragraph 1, for use in the method of any preceding paragraph    (eg, for use in the method of any of paragraphs 1 to 8 and 19 to    23).-   50. The ligand of paragraph 49, wherein the ligand is an anti-TOI    trap, antibody or antibody fragment.-   51. The ligand of paragraph 49 or 50, wherein the ligand is for    subcutaneous or intravenous administration to a human, or is    comprised by an injectable preparation.-   52. An injection device comprising the ligand of any one of    paragraphs 49 to 51.

Additional Tailoring of Ligands to Genotype and/or Phenotype of theHuman Patient

As described herein, the present invention contemplates ligands (eg,antibodies and fragments) whose binding site specificities have beenmatched to one or more variant human TOIs (eg, PCSK9 or IL6R).Additionally or alternatively (and as further illustrated in thenon-limiting Examples below), an optional aspect of the inventionprovides for matching of other features of the ligand to the patient'sgenotype or phenotype. In this respect, for example, the inventionincludes the ability to match amino acid sequence variation in a humanpatient to one or more ligand sequences or domains outside of thebinding sites. For example, where the ligand comprises or consists of ahuman TOI-binding antibody or an anti-human TOI receptor Fc fusion, thisaspect of the invention provides for more tailored matching of one ormore constant region domains (eg, the Fc) to the patient genotype orphenotype. Additionally or alternatively, it is contemplated thatsequence variation in the binding site can be similarly matched to thepatient's genotype or phenotype. The present inventor has done this byconsidering the SNP occurrences in sequences encoding one or more partsof the ligand, eg, SNP occurrences in one, more or all of the genesegments from which the variable domain(s) and/or constant regiondomain(s) are derived. The inventor realised that it would be desirableto match the ligand to one or more corresponding variant SNPs found inthe patient to be treated therapeutically and/or prophylactically.Matching could involve designing the ligand specifically for a patientof known phenotype and/or genotype, or matching could involve choosing aligand by determining that there is correspondence between variation inthe patient's phenotype or genotype with the variation in the ligandamino acid and/or corresponding nucleotides.

A key consideration for the inventor was the desire to promotecompatibility of the ligand with the patient's body, and in particular,the possible patient immune system responses to administered ligands.For example, it has been observed that human patients receiving human orhumanised antibody drugs may mount an immune response against theincoming antibody (a so-called HAHA response) which results in thepatient producing anti-drug antibodies as a result of the patient'simmune system recognising the drug as foreign. For example, studies havesuggested that some patients receiving HUMIRA™ (adalimumab), currentlythe biggest selling antibody medicine, mount a HAHA immune responseagainst the medicine, and this may impact treatment adversely. Referenceis made to JAMA. 2011; 305(14):1460-1468. doi:10.1001/jama.2011.406:“Development of Antidrug Antibodies Against Adalimumab and AssociationWith Disease Activity and Treatment Failure During Long-term Follow-up”,GM Bartelds et al. The authors concluded that results of this studyshowed that development of antidrug antibodies was associated with anegative outcome of adalimumab treatment in human RA patients. It wasreported that not only did patients with anti-adalimumab antibodiesdiscontinue treatment more often and earlier than patients withoutanti-adalimumab antibodies, they also had a higher disease activityduring treatment and only rarely came into remission. In addition,reportedly the data showed that two-thirds of the anti-adalimumabantibody-positive patients developed these antibodies in the first 28weeks of treatment and that the presence of anti-adalimumab antibodiessubstantially influenced serum adalimumab concentrations.

This HAHA theme is, therefore, a significant concern and this has beenconsidered by the regulatory authorities. For example, the EuropeanMedicines Agency (EMA) has issued a “Guideline on immunogenicityassessment of monoclonal antibodies intended for in vivo clinical use”(available on the world wide web atema.europa.eu/docs/en_GB/documentlibrary/Scientific_guideline/2012/06/WC500128688.pdf;EMA/CHMP/BMWP/86289/2010, addendum to EMEA/CHMP/BMWP/14327/2006), whichcame into force on 1^(st) December 2012. As such, it is good practicefor researchers to identify and assess risk of anti-antibody drugoccurrence and effects.

The present aspect of the invention, by more closely tailoring theligand itself (as well as its specificity) to the patient, helps toaddress these considerations when designing and administering anti-humanTOI medicines for treating and/or preventing human TOI-related diseasesand conditions.

The inventor also considered the desirability to tailor the variation inthe ligand constant region (eg, for an antibody or Fc-containingligand), mindful that then the constant region being administered to thepatient would be tuned to the various components, such as patient's Fcreceptors, that would interact with the constant region in the patient.Good Fc/Fc receptor interactions can be important for drug recycling(via the FcRn) to provide for useful half-lives in vivo or for use incell killing, eg, for cancer indications. In this way it is possible,therefore, to tune the effector function of the constant region (eg, Fc)to the patient more closely, to promote efficacy. For example, moreefficacious drugs are desirable for better patient treatment and mayprovide the possibility of lowered dosing and/or dosing frequencies.

Thus, in examples of this aspect, the invention provides the following(set out as clauses):—

-   1. The ligand, method, use, kit or composition of the invention,    wherein    -   (i) the ligand (eg, antibody or fragment) comprises        -   (c) a variable domain that is encoded by a human V region            nucleotide sequence, wherein the V nucleotide sequence is            derived from recombination of human VH, D and JH gene            segments or human VL and JL gene segments; or        -   (d) a constant region domain encoded by a C region gene            segment; Wherein a first gene segment of said gene segments            of (a), or said C region gene segment of        -   (b) comprises a first single nucleotide polymorphism (SNP)            encoding a first amino acid polymorphism; and    -   (ii) the genome of said human comprises said first SNP or        wherein said human expresses (a′) an antibody variable domain        comprising said first amino acid polymorphism or (b′) an        antibody constant domain comprising said first amino acid        polymorphism.-   2. The ligand, method, use, kit or composition of clause 1, wherein    blood of said human comprises substantially no antibodies that    specifically bind to the domain comprising said first amino acid    polymorphism as determined in an in vitro binding assay.-   3. The ligand, method, use, kit or composition of clause 2, wherein    SPR is used to carry out said assay.    -   In an alternative, ELISA is used.-   4. The ligand, method, use, kit or composition of any one of clauses    1 to 3, wherein the genome of said human comprises said first gene    segment (when (a) applies) or said C region gene segment (when (b)    applies).-   5. The ligand, method, use, kit or composition of any one of clauses    1 to 4, wherein said first segment or a second segment of said    segments of (a), or said C region gene segment of (b), comprises a    second SNP encoding a second amino acid polymorphism; and wherein    the genome of said human comprises said second SNP or wherein said    human expresses (a″) an antibody variable domain comprising said    second amino acid polymorphism or (b″) an antibody constant region    domain comprising said first and second amino acid polymorphisms.-   6. The ligand, method, use, kit or composition of clause 5, wherein    said human expresses an antibody variable domain comprising said    first and second amino acid polymorphisms.-   7. The ligand, method, use, kit or composition of clause 5 or 6,    wherein the first and second SNPs of said genome are comprised by    the same antibody gene segment.    -   For example, the first and second SNPs of the genome are        comprised by an IGHG1*01 gene segment and said first segment        of (a) is an IGHG1*01 gene segment.    -   For example, the first and second SNPs of the genome are        comprised by an IGHG2*01 gene segment and said first segment        of (a) is an IGHG2*01 gene segment.-   8. The ligand, method, use, kit or composition of any one of clauses    1 to 7, wherein each SNP is a variable region gene segment SNP.-   9. The ligand, method, use, kit or composition of any one of clauses    1 to 7, wherein each SNP is a constant region gene segment SNP, eg    each SNP is a gamma-1 constant region gene segment SNP, or a gamma-2    constant region gene segment SNP, or a gamma-3 constant region gene    segment SNP or a gamma-4 constant region gene segment SNP.-   10. The ligand, method, use, kit or composition of clause 9, wherein    the first SNP is a CH1, CH2, CH3 or CH4 gene segment SNP and/or the    second SNP is a CH1, CH2, CH3 or CH4 gene segment SNP.-   11. The ligand, method, use, kit or composition of any one of    clauses 1 to 8, wherein each SNP is a variable domain SNP, eg, a VH    domain SNP, or a Vκ domain SNP, or a Vλ SNP.-   12. The ligand, method, use, kit or composition of any one of    clauses 1 to 11, wherein said constant region domain of (b) is    comprised by an antibody Fc region.-   13. The ligand, method, use, kit or composition of any one of    clauses 1 to 12, wherein the ligand (eg, antibody or fragment) has    been determined to specifically bind one or more human TOI variants    as disclosed herein, for example, with a KD of 1 nM or less (eg, 100    or 10 pM or less) as determined by SPR.-   14. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 13), wherein the ligand    comprises or consists of an antibody or fragment that comprises a    human antibody variable domain derived from the recombination of a    human V gene segment and a human J gene segment (and optionally a    human D gene segment when the variable domains are VH domains); and    wherein the genome of the human comprises said human V gene segment    and/or the human expresses antibodies comprising antibody variable    domains derived from the recombination of said human V gene segment    and a human J gene segment (and optionally a human D gene segment).    -   In an example, the V gene segment is any of the V gene segments        disclosed in WO2013041844, a 1000 Genomes database and/or        www.imgt.org, the disclosures of which (including disclosure        relating to sequence) is explicitly incorporated herein by        reference for use in the present invention.-   15. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 14), wherein the ligand    (eg, comprising or consisting of an antibody or fragment or an    Fc-fused human TOI receptor) comprises a human heavy chain constant    domain encoded by a first constant region nucleotide sequence; and    wherein the genome of the human comprises a heavy chain constant    region nucleotide sequence that is identical to said first constant    region nucleotide sequence and/or the human expresses antibodies    comprising said human constant domain.-   16. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 15), wherein the ligand    (eg, comprising or consisting of an antibody or fragment or an    Fc-fused human TOI receptor) comprises a human gamma heavy chain CH1    domain encoded by a CH1 nucleotide sequence; and wherein the genome    of the human comprises a gamma heavy chain constant region    nucleotide sequence that is identical to said CH1 nucleotide    sequence and/or the human expresses antibodies comprising said human    gamma CH1 domain.-   17. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 16), wherein the ligand    (eg, comprising or consisting of an antibody or fragment or an    Fc-fused human TOI receptor) comprises a human gamma heavy chain CH2    domain encoded by a CH2 nucleotide sequence; and wherein the genome    of the human comprises a gamma heavy chain constant region    nucleotide sequence that is identical to said CH2 nucleotide    sequence and/or the human expresses antibodies comprising said human    gamma CH2 domain.-   18. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 17), wherein the ligand    (eg, comprising or consisting of an antibody or fragment or an    Fc-fused human TOI receptor) comprises a human gamma heavy chain CH3    domain encoded by a CH3 nucleotide sequence; and wherein the genome    of the human comprises a gamma heavy chain constant region    nucleotide sequence that is identical to said CH3 nucleotide    sequence and/or the human expresses antibodies comprising said human    gamma CH3 domain.-   19. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 18), wherein the ligand    (eg, comprising or consisting of an antibody or fragment or an    Fc-fused human TOI receptor) comprises a human gamma heavy chain CH4    domain encoded by a CH4 nucleotide sequence; and wherein the genome    of the human comprises a gamma heavy chain constant region    nucleotide sequence that is identical to said CH4 nucleotide    sequence and/or the human expresses antibodies comprising said human    gamma CH4 domain.-   20. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 19), wherein the ligand    (eg, comprising or consisting of an antibody or fragment or an    Fc-fused human TOI receptor) comprises a human gamma heavy chain Fc    region encoded by a Fc nucleotide sequence; and wherein the genome    of the human comprises a gamma heavy chain constant region    nucleotide sequence that is identical to said Fc nucleotide sequence    and/or the human expresses antibodies comprising said human gamma Fc    region.-   21. The ligand, method, use, kit or composition of any one of    clauses 16 to 20, wherein said human gamma heavy chain is a human    gamma-1 heavy chain.-   22. The ligand, method, use, kit or composition of any one of    clauses 16 to 20, wherein said human gamma heavy chain is a human    gamma-2 heavy chain.-   23. The ligand, method, use, kit or composition of any one of    clauses 16 to 20, wherein ligand comprises a human IGHG1*01 gamma-1    heavy chain constant region.-   24. The ligand, method, use, kit or composition of any one of    clauses 16 to 20, wherein ligand comprises a human IGHG2*01 gamma-1    heavy chain constant region.-   25. The ligand, method, use, kit or composition of any one of    clauses 15 to 24, wherein the human has been or is genotyped as    positive for said heavy chain constant region nucleotide sequence.-   26. The ligand, method, use, kit or composition of clause 23,    wherein the human has been or is genotyped as positive for human    IGHG1*01 nucleotide sequence.-   27. The ligand, method, use, kit or composition of clause 24,    wherein the human has been or is genotyped as positive for human    IGHG2*01 nucleotide sequence.-   28. The ligand, method, use, kit or composition of any one of    clauses 16 to 24, wherein the human has been or is phenotyped as    positive for said gamma heavy chain constant domain, CH1, CH2, CH3,    CH4 or Fc.-   29. The ligand, method, use, kit or composition of clause 28, (i)    when dependent from clause 23, wherein the human has been or is    phenotyped as positive for a human IGHG1*01 gamma heavy chain    constant domain, CH1, CH2, CH3, CH4 or Fc or (ii) when dependent    from clause 24, wherein the human has been phenotyped as positive    for a human IGHG2*01 gamma heavy chain constant domain, CH1, CH2,    CH3, CH4 or Fc.-   30. The method or use of any one of clauses 16 to 24 and 26 to 29,    comprising genotyping the human as positive for said gamma heavy    chain constant region nucleotide sequence, eg, positive for said    gamma heavy chain constant domain, CH1, CH2, CH3, CH4 or Fc    nucleotide sequence; positive for said human IGHG1*01 gamma heavy    chain constant region, CH1, CH2, CH3, CH4 or Fc nucleotide sequence;    or positive for said human IGHG2*01 gamma heavy chain constant    region, CH1, CH2, CH3, CH4 or Fc nucleotide sequence.-   31. The method or use of any one of clauses 16 to 24 and 26 to 30,    comprising phenotyping the human as positive for said gamma heavy    chain constant region, eg, positive for said gamma heavy chain    constant domain, CH1, CH2, CH3, CH4 or Fc; positive for said human    IGHG1*01 gamma heavy chain constant domain, CH1, CH2, CH3, CH4 or    Fc; or positive for said human IGHG2*01 gamma heavy chain constant    domain, CH1, CH2, CH3, CH4 or Fc.

Examples of Tailored Ligands

The inventor analysed amino acid variability and distribution amongstlarge representative human samples. The result of the analysis forexample antibody gene segments is shown in Table 9.

In a first example, the inventor identified the possibility ofaddressing the rarer IGH-gamma-1 SNPs 204D (observed cumulativefrequency of 0.296) and 206L (observed cumulative frequency of 0.283)individually or in combination. These residues are part of the CH3domain, and as such they form part of antibody Fc regions. Thus,matching of these CH3 variations with the patient is especiallybeneficial for reasons as discussed above. Thus, this example providesaspects set out in the following clauses.

-   32. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 31), wherein the ligand    (eg, comprising or consisting of an antibody or fragment or an    Fc-fused TOI receptor) comprises a human gamma-1 heavy chain    constant region that comprises an Asp corresponding to position 204    of SEQ ID NO: 42 or a Leu corresponding to position 206 of SEQ ID    NO: 42 and wherein the genome of the human comprises a gamma-1 heavy    chain constant region nucleotide sequence that encodes such an Asp    or Leu or the human expresses antibodies comprising human gamma-1    constant regions comprising such an Asp or Leu.    -   The skilled person will be familiar with techniques for        determining genome sequences of a human, eg, by using a sample        containing genomic DNA and/or RNA, sequencing and comparing        using bioinformatics or other computer tools to compare the        sampled sequence with sequences of human alleles (eg, as shown        in the IMGT, 100 genomes or other database as disclosed herein).        In an example, the sample is a blood or saliva or cheek swab        sample.-   33. The ligand, method, use, kit or composition of clause 32,    wherein the ligand comprises a human gamma-1 heavy chain constant    region that comprises an Asp corresponding to position 204 of SEQ ID    NO: 42 and a Leu corresponding to position 206 of SEQ ID NO: 42.-   34. The ligand, method, use, kit or composition of clause 32 or 33,    wherein the genome of the human comprises a gamma-1 heavy chain    constant region nucleotide sequence that encodes such an Asp and Leu    or the human expresses antibodies comprising human gamma-1 constant    regions comprising such an Asp and Leu.-   35. The ligand, method, use, kit or composition of clause 32, 33 or    34, wherein the ligand comprises a human IGHG1*01 gamma-1 heavy    chain constant region, eg, an Fc, CH1, CH2 and/or CH3 domain encoded    by human IGHG1*01.-   36. The ligand, method, use, kit or composition of any one of    clauses 32 to 35, wherein the genome of the human comprises a human    IGHG1*01 nucleotide sequence or the human expresses antibodies    comprising human constant domains encoded by a human IGHG1*01    nucleotide sequence.-   37. The ligand, method, use, kit or composition of any one of    clauses 32 to 36, wherein the ligand comprises a hinge region    encoded by human IGHG1*01.-   38. The ligand, method, use, kit or composition of any one of    clauses 32 to 37, wherein the ligand comprises or consists of an    antibody, wherein the antibody comprises heavy chains that comprise    SEQ ID NO: 61.-   39. The ligand, method, use, kit or composition of any one of    clauses 32 to 38, wherein the human is of European ancestry.    -   As shown in Table 9, 204D and 206L are found in such humans.-   40. The ligand, method, use, kit or composition of any one of    clauses 32 to 39, wherein the human has been or is genotyped as    positive for said Asp and/or Leu.-   41. The ligand, method, use, kit or composition of any one of    clauses 32 to 40, wherein the human has been or is genotyped as    positive for human IGHG1*01.-   42. The ligand, method, use, kit or composition of any one of    clauses 32 to 41, wherein the human has been or is phenotyped as    positive for a human IGHG1*01 CH3.-   43. The method or use of any one of clauses 32 to 42, comprising    selecting a said human whose genome comprises a codon(s) encoding    said Asp and/or Leu; comprises human IGHG1*01; or comprises a human    IGHG1*01 CH3.-   44. The method or use of any one of clauses 32 to 43, comprising    selecting a said human whose phenotype comprises said Asp and/or    Leu; a human IGHG1*01 region; or a human IGHG1*01 CH3.    -   44a. The ligand, method, use, kit or composition of any one of        clauses 32 to 44, wherein the human expresses antibodies        comprising human gamma-1 constant regions comprising such an Asp        and Leu.

In a second example, the inventor identified the possibility ofaddressing IGH-gamma-2 SNPs. This included consideration of Fc regionvariation—in this respect, the inventor focused on positions 161 and 257which are in the Fc region. Thus, this example provides aspects set outin the following clauses.

-   45. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 31), wherein the ligand    (eg, comprising or consisting of an antibody or fragment or an    Fc-fused TOI receptor) comprises a human gamma-2 heavy chain    constant region that comprises an amino acid selected from the group    consisting of a Pro corresponding to position 72 of SEQ ID NO: 44,    an Asn corresponding to position 75 of SEQ ID NO: 44, a Phe    corresponding to position 76 of SEQ ID NO: 44, a Val corresponding    to position 161 of SEQ ID NO: 44 and an Ala corresponding to    position 257 of SEQ ID NO: 44; and wherein the genome of the human    comprises a gamma-2 heavy chain constant region nucleotide sequence    that encodes such a selected amino acid or the human expresses    antibodies comprising human gamma-2 constant regions comprising such    a selected amino acid.-   46. The ligand, method, use, kit or composition of clause 45,    wherein the ligand comprises a human gamma-2 heavy chain constant    region that comprises (i) a Pro corresponding to position 72 of SEQ    ID NO: 44, an Asn corresponding to position 75 of SEQ ID NO: 44, a    Phe corresponding to position 76 of SEQ ID NO: 44 and    optionally (ii) a Val corresponding to position 161 of SEQ ID NO: 44    and/or an Ala corresponding to position 257 of SEQ ID NO: 44; and    wherein the genome of the human comprises a gamma-2 heavy chain    constant region nucleotide sequence that encodes such amino acids    of (i) or the human expresses antibodies comprising human gamma-2    constant regions comprising such amino acids of (i).    -   This example focuses on CH1 variation.-   47. The ligand, method, use, kit or composition of clause 45 or 46,    wherein the ligand comprises a human gamma-2 heavy chain constant    region that comprises (i) a Val corresponding to position 161 of SEQ    ID NO: 44 and an Ala corresponding to position 257 of SEQ ID NO: 44    and optionally (ii) an amino acid selected from the group consisting    of a Pro corresponding to position 72 of SEQ ID NO: 44, an Asn    corresponding to position 75 of SEQ ID NO: 44 and a Phe    corresponding to position 76 of SEQ ID NO: 44; and wherein the    genome of the human comprises a gamma-2 heavy chain constant region    nucleotide sequence that encodes such amino acids of (i) or the    human expresses antibodies comprising human gamma-2 constant regions    comprising such amino acids of (i).    -   This example focuses on Fc variation.-   48. The ligand, method, use, kit or composition of any one of    clauses 45 to 47, wherein the ligand comprises a human IGHG2*01    gamma-2 heavy chain constant region, eg, an Fc, CH1, CH2 and/or CH3    domain encoded by human IGHG2*01.-   49. The ligand, method, use, kit or composition of any one of    clauses 45 to 48, wherein the genome of the human comprises a human    IGHG2*01 nucleotide sequence or the human expresses antibodies    comprising human constant domains encoded by a human IGHG2*01    nucleotide sequence.-   50. The ligand, method, use, kit or composition of any one of    clauses 45 to 49, wherein the ligand comprises a hinge region    encoded by human IGHG2*01.-   51. The ligand, method, use, kit or composition of any one of    clauses 45 to 50, wherein the ligand comprises or consists of an    antibody, wherein the antibody comprises heavy chains that comprise    SEQ ID NO: 63 or 65.-   52. The ligand, method, use, kit or composition of any one of    clauses 45 to 51, wherein the human is of European, African    American, or European American ancestry.-   53. The ligand, method, use, kit or composition of any one of    clauses 45 to 52, wherein the human has been or is genotyped as    positive for one, more or all of said Pro, Asn, Phe, Val and Ala.-   54. The ligand, method, use, kit or composition of any one of    clauses 45 to 53, wherein the human has been or is genotyped as    positive for human IGHG2*01.-   55. The ligand, method, use, kit or composition of any one of    clauses 45 to 54, wherein the human has been or is phenotyped as    positive for a human IGHG2*01 CH1.-   56. The ligand, method, use, kit or composition of any one of    clauses 45 to 55, wherein the human has been or is phenotyped as    positive for a human IGHG2*01 CH2.-   57. The ligand, method, use, kit or composition of any one of    clauses 45 to 56, wherein the human has been or is phenotyped as    positive for a human IGHG2*01 CH3.-   58. The method or use of any one of clauses 45 to 57, comprising    selecting a said human whose genome comprises a codon(s) encoding    one, more or all of said Pro, Asn, Phe, Val and Ala; comprises human    IGHG2*01; or comprises a human IGHG2*01 CH1, CH2 and/or CH3.-   59. The method or use of any one of clauses 45 to 58, comprising    selecting a said human whose phenotype comprises one, more or all of    said Pro, Asn, Phe, Val and Ala; a human IGHG2*01 region; or a human    IGHG2*01 CH1, CH2 and/or CH3.-   60. The ligand, method, use, kit or composition of any one of    clauses 45 to 59, wherein the human expresses antibodies comprising    human gamma-2 constant regions comprising such a Pro, Asn, Phe, Val    and Ala.

In a third example, the inventor addressed human kappa constant regionvariation. Thus, the present aspect of the invention also provides thefollowing.

-   61. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 60), wherein the ligand    (eg, comprising or consisting of an antibody or fragment or an    Fc-fused TOI receptor) comprises a human kappa light chain constant    region that comprises a Val corresponding to position 84 of SEQ ID    NO: 50 or a Cys corresponding to position 87 of SEQ ID NO: 50; and    wherein the genome of the human comprises a kappa light chain    constant region nucleotide sequence that encodes such a Val or Cys    or the human expresses antibodies comprising human kappa light chain    constant regions comprising such a Val or Cys.-   62. The ligand, method, use, kit or composition of clause 61,    wherein the ligand comprises a human kappa light chain constant    region that comprises a Val corresponding to position 84 of SEQ ID    NO: 50 and a Cys corresponding to position 87 of SEQ ID NO: 50.-   63. The ligand, method, use, kit or composition of clause 61 or 62,    wherein the genome of the human comprises a kappa light chain    constant region nucleotide sequence that encodes such a Val and Cys    or the human expresses antibodies comprising human kappa constant    regions comprising such a Val and Cys.-   64. The ligand, method, use, kit or composition of any one of    clauses 61 to 63, wherein the antibody or fragment comprises a human    IGKC*01 kappa light chain constant region.-   65. The ligand, method, use, kit or composition of any one of    clauses 61 to 64, wherein the ligand comprises or consists of an    antibody, wherein the antibody comprises light chains that comprise    SEQ ID NO: 62 or 66.-   66. The ligand, method, use, kit or composition of any one of    clauses 61 to 65, wherein the ligand comprises or consists of an    antibody, wherein the antibody comprises a light chain variable    domain derived from recombination of a human Vκ gene segment and a    human Jκ gene segment, wherein the Jκ gene segment is IGKJ2*01 (SEQ    ID NO: 57).-   67. The ligand, method, use, kit or composition of any one of    clauses 61 to 66, wherein the human has been or is phenotyped as    positive for said Val and/or Cys.-   68. The ligand, method, use, kit or composition of any one of    clauses 61 to 67, wherein the human has been or is genotyped as    positive for human IGKC*01.-   69. The ligand, method, use, kit or composition of any one of    clauses 61 to 68, wherein the human has been or is phenotyped as    positive for a human IGKC*01 domain.-   70. The method or use of any one of clauses 61 to 69, comprising    selecting a said human whose genome comprises a codon(s) encoding    said Val and/or Cys; or comprises human IGKC*01.-   71. The method or use of any one of clauses 61 to 70, comprising    selecting a said human whose phenotype comprises such a Val and/or    Cys; or comprises a human IGKC*01 domain.-   72. The ligand, method, use, kit or composition of any one of    clauses 61 to 71, wherein the human expresses antibodies comprising    human kappa constant domains comprising such a Val and Cys, eg,    expresses human IGKC*01 constant domains.

In a fourth example, the inventor addressed human lambda constant regionvariation. Thus, this example provides aspects set out in the followingclauses.

-   73. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 60), wherein the ligand    (eg, comprising or consisting of an antibody or fragment or an    Fc-fused TOI receptor) comprises a human IGLC2*01 light chain    constant region; and wherein the genome of the human comprises a    human IGLC2*01 nucleotide sequence or the human expresses antibodies    comprising human light chain IGLC2*01 constant regions.-   74. The ligand, method, use, kit or composition of clause 73,    wherein the antibody comprises light chains that comprise SEQ ID NO:    64.-   75. The ligand, method, use, kit or composition of clause 73 or 74,    wherein the human has been or is genotyped as positive for human    IGLC2*01.-   76. The ligand, method, use, kit or composition of any one of    clauses 73 to 75, wherein the human has been or is phenotyped as    positive for a human IGLC2*01 domain.-   77. The method or use of any one of clauses 73 to 76, comprising    selecting a said human whose genome comprises human IGLC2*01.-   78. The method or use of any one of clauses 73 to 77, comprising    selecting a said human whose phenotype comprises a human IGLC2*01    domain.-   79. The ligand, method, use, kit or composition of any one of    clauses 73 to 78, wherein the human expresses antibodies comprising    human lambda IGLC2*01 constant domains.

In a fifth example, the inventor addressed human heavy chain variableregion variation. Thus, this example provides aspects set out in thefollowing clauses.

-   80. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 79), wherein the ligand    comprises or consists of an antibody or fragment, wherein the    antibody or fragment comprises a VH domain that is derived from the    recombination of a human VH gene segment, a human D gene segment and    a human JH gene segment, wherein the VH gene segment is selected    from the group consisting of (i) IGHV1-18*01 and the genome of the    human comprises a human IGHV1-18*01 nucleotide sequence or the human    expresses antibodies comprising variable domains derived from the    recombination of human IGHV1-18*01; or (ii) IGVH1-46*01 and the    genome of the human comprises a human IGHV1-46*01 nucleotide    sequence or the human expresses antibodies comprising variable    domains derived from the recombination of human IGHV1-46*01.-   81. The ligand, method, use, kit or composition of clause 80,    wherein the antibody or fragment comprises a one more or all of a    CH1 domain, CH2 domain, CH3 domain, hinge or Fc encoded by human    IGHG2*01.-   82. The ligand, method, use, kit or composition of clause 80 or 81,    wherein the antibody or fragment comprises heavy chains that    comprise SEQ ID NO: 63 or 65.-   83. The ligand, method, use, kit or composition of any one of    clauses 80 to 82, wherein the human has been or is genotyped as    positive for said selected VH gene segment, positive for human    IGHV1-18*01 or IGVH1-46*01.-   84. The method or use of any of clauses 80 to 83, comprising    genotyping the human as positive for said selected VH gene segment,    eg, positive for human IGHV1-18*01 or IGVH1-46*01.

In a sixth example, the inventor addressed human light chain variableregion variation. Thus, this example provides aspects set out in thefollowing clauses.

-   85. The ligand, method, use, kit or composition of the invention    (eg, according to any one of clauses 1 to 84), wherein the ligand    comprises or consists of an antibody or fragment, wherein the    antibody or fragment comprises a VL domain that is derived from the    recombination of a human VL gene segment and a human JL gene    segment, wherein the VL gene segment is selected from the group    consisting of (i) IGKV4-1*01 and the genome of the human comprises a    human IGKV4-1*01 nucleotide sequence or the human expresses    antibodies comprising variable domains derived from the    recombination of human IGKV4-1*01; (ii) IGLV2-14*01 and the genome    of the human comprises a human IGLV2-14*01 nucleotide sequence or    the human expresses antibodies comprising variable domains derived    from the recombination of human IGLV2-14*01; or (iii) IGKV1-13*02    and the genome of the human comprises a human IGKV1-13*02 nucleotide    sequence or the human expresses antibodies comprising variable    domains derived from the recombination of human IGKV1-13*02.-   86. The ligand, method, use, kit or composition of clause 85,    wherein the antibody comprises light chains that comprise SEQ ID NO:    62, 64 or 66.-   87. The ligand, method, use, kit or composition of clause 85 or 86,    wherein the antibody or fragment comprises a light chain variable    domain derived from recombination of a human Vκ gene segment and a    human Jκ gene segment, wherein the Jκ gene segment is IGKJ2*01 (SEQ    ID NO: 57; wherein (i) or (iii) applies.-   88. The ligand, method, use, kit or composition of any one of    clauses 85 to 87, wherein the human has been or is genotyped as    positive for said selected VL gene segment, eg, positive for human    IGKV4-1*01, IGLV2-14*01 or IGKV1-13*02.-   89. The method or use of clause 88, comprising genotyping the human    as positive for said selected VL gene segment, eg, genotyping the    human as positive for human IGKV4-1*01, IGLV2-14*01 or IGKV1-13*02.-   90. The ligand, method, use, kit or composition of any one of    clauses 1 to 89, wherein the ligand (eg, antibody or fragment) binds    said human TOI with a dissociation constant (Kd) of 1 nM or less as    determined by SPR, (eg, 100, 10 or 1pM or less).

In a specific embodiment, the ligand, antibody or fragment of presentinvention comprises an Fc region, wherein the Fc region comprises atleast one non-native amino acid residue selected from the groupconsisting of 234D, 234E, 234N, 234Q, 234T, 234H, 234Y, 2341, 234V,234F, 235A, 235D, 235R, 235W, 235P, 235S, 235N, 235Q, 235T, 235H, 235Y,235I, 235V, 235F, 236E, 239D, 239E, 239N, 239Q, 239F, 239T, 239H, 239Y,240I, 240A, 240T, 240M, 241W, 241 L, 241Y, 241E, 241R. 243W, 243L 243Y,243R, 243Q, 244H, 245A, 247L, 247V, 247G, 251F, 252Y, 254T, 255L, 256E,256M, 262I, 262A, 262T, 262E, 263I, 263A, 263T, 263M, 264L, 264I, 264W,264T, 264R, 264F, 264M, 264Y, 264E, 265G, 265N, 265Q, 265Y, 265F, 265V,265I, 265L, 265H, 265T, 266I, 266A, 266T, 266M, 267Q, 267L, 268E, 269H,269Y, 269F, 269R, 270E, 280A, 284M, 292P, 292L, 296E, 296Q, 296D, 296N,296S, 296T, 296L, 296I, 296H, 269G, 297S, 297D, 297E, 298H, 298I, 298T,298F, 299I, 299L, 299A, 299S, 299V, 299H, 299F, 299E, 305I, 313F, 316D,325Q, 325L, 325I, 325D, 325E, 325A, 325T, 325V, 325H, 327G, 327W, 327N,327L, 328S, 328M, 328D, 328E, 328N, 328Q, 328F, 328I, 328V, 328T, 328H,328A, 329F, 329H, 329Q, 330K, 330G, 330T, 330C, 330L, 330Y, 330V, 330I,330F, 330R, 330H, 331G, 331A, 331L, 331M, 331F, 331W, 331K, 331Q, 331E,331S, 331V, 331I, 331C, 331Y, 331H, 331R, 331N, 331D, 331T, 332D, 332S,332W, 332F, 332E, 332N, 332Q, 332T, 332H, 332Y, 332A, 339T, 370E, 370N,378D, 392T, 396L, 416G, 419H, 421K, 440Y and 434W as numbered by the EUindex as set forth in Kabat. Optionally, the Fc region may compriseadditional and/or alternative non-native amino acid residues known toone skilled in the art (see, e.g., U.S. Pat. Nos. 5,624,821; 6,277,375;6,737,056; PCT Patent Publications WO 01/58957; WO 02/06919; WO04/016750; WO 04/029207; WO 04/035752 and WO 05/040217).

In an example the ligand, antibody or fragment comprises one or morehuman binding sites that specifically bind the TOI (eg, PCSK9, IL4Ra,IL6R, VEGFA or Nav1.7). In an embodiment, the binding sites comprise orconsist of human antibody variable domains or human receptors for theTOI (eg, Human receptor binding sites for VEGFA). Furthermore, theligand, antibody or fragment can be optionally fully human (eg,comprising human constant regions, eg, human Fc regions with or withouthuman CL regions). In an example, the ligand is aflibercept, alirocumab,sarilumab or dupilumab. Fully human ligands maximise compatibility withthe human patient when used in the context of the invention wherein theV and/or C regions are tailored to the human genotype and/or phenotypeas per the description herein.

Some embodiments of the technology described herein can be definedaccording to any of the following numbered paragraphs:

-   1. A method of treating or preventing a disease or condition in a    human, wherein the disease or condition is mediated by a Target of    Interest (TOI), wherein the TOI is present in humans as different    polymorphic variants, the method comprising    -   a. Administering to the human an anti-TOI ligand to target a TOI        variant in the human and treat or prevent said disease or        condition, wherein the TOI in said human is encoded by a        nucleotide sequence having a cumulative human allele frequency        of less than 50% and/or wherein the TOI in said human is encoded        by a nucleotide sequence having a total human genotype frequency        of less than 50%;        -   wherein    -   b. Before step (a) said human has been or is genotyped as        positive for said nucleotide sequence or phenotyped as positive        for said TOI variant.-   2. The method of paragraph 1, wherein before step (a) the ligand has    been or is determined as being capable of binding to said TOI    variant.-   3. A method of treating or preventing a disease or condition in a    human, wherein the disease or condition is mediated by a Target of    Interest (TOI), wherein the TOI is present in humans as different    polymorphic variants, the method comprising    -   a. Administering to the human an anti-TOI ligand to target a TOI        variant in the human and treat or prevent said disease or        condition, wherein the TOI in said human is encoded by a        nucleotide sequence having a cumulative human allele frequency        of less than 50% and/or wherein the TOI in said human is encoded        by a nucleotide sequence having a total human genotype frequency        of less than 50%;        -   wherein    -   b. Before step (a) the ligand has been or is determined as        capable of binding to said TOI variant.-   4. The method of paragraph 3, wherein the genome of said human    comprises a nucleotide sequence encoding said TOI variant; and    before step (a) said nucleotide sequence has been or is determined    as having a cumulative human allele frequency of less than 50%    and/or having a total human genotype frequency of less than 50%.-   5. The method of paragraph 3 or 4, wherein said human has been or is    genotyped as positive for said variant nucleotide sequence before    step (a).-   6. The method of any preceding paragraph, wherein the human has been    or is phenotyped as positive for said TOI variant before step (a).-   7. The method of any preceding paragraph, wherein said frequency is    less than 10 or 15%.-   8. The method of any preceding paragraph, wherein the ligand is    capable of binding to two or more different TOI variants, each being    encoded by a nucleotide sequence having a cumulative human allele    frequency of less than 50% and/or having a total human genotype    frequency of less than 50%.-   9. A method of treating or preventing a disease or condition in a    human, wherein the disease or condition is mediated by a Target of    Interest (TOI), wherein the TOI is present in humans as different    polymorphic variants, the method comprising    -   a. Administering to the human an anti-TOI ligand to target a TOI        variant in the human and treat or prevent said disease or        condition, wherein the TOI in said human is a variant encoded by        a nucleotide sequence having a cumulative human allele frequency        of more than 50% and/or having a total human genotype frequency        of more than 50%;        -   wherein    -   b. Before step (a) said human has been or is genotyped as        negative for a variant nucleotide sequence having a cumulative        human allele frequency of less than 50% and/or having a total        human genotype frequency of less than 50%; or phenotyped as        negative for a TOI variant encoded by a nucleotide sequence        having a cumulative human allele frequency of less than 50%        and/or having a total human genotype frequency of less than 50%.-   10. The method of paragraph 9, wherein before step (a), the human    has been or is phenotyped as positive for the most frequent TOI    variant or genotyped for the nucleotide sequence thereof.-   11. The method of paragraph 9 or 10, wherein before step (a) the    ligand has been or is determined as being capable of binding to the    most frequent TOI variant.-   12. The method of paragraph 9, 10 or 11, wherein before step (a) the    ligand has been or is determined as being substantially incapable of    neutralising or inhibiting said TOI variant recited in step (b).-   13. The method of any one of paragraphs 9 to 12, wherein the ligand    is capable of binding to the most frequent TOI variant.-   14. The method of any one of paragraphs 9 to 13, wherein the ligand    is capable of binding to two or more different TOI variants, each    being encoded by a nucleotide sequence having a cumulative human    allele frequency of more than 50%.-   15. The method of any preceding paragraph, wherein said variant    nucleotide sequence recited in step (a) has been or is determined as    being present in at least 2 different human ethnic populations.-   16. The method of any preceding paragraph, wherein said human    frequency is the frequency in a database of naturally-occurring    sequences sampled from at least 15 different human ethnic    populations and comprising at least 1000 sequences.-   17. An anti-human TOI ligand for use in a method of treating and/or    preventing a TOI-mediated disease or condition in a human, wherein    the TOI is present in humans as different polymorphic variants and    wherein the genome of said human comprises a TOI nucleotide sequence    having a cumulative human allele frequency of less than 50% and/or a    total human genotype frequency of less than 50%, the method    comprising administering the ligand to the human.-   18. The ligand of paragraph 17, wherein the ligand has been or is    determined as capable of binding the human TOI encoded by said    nucleotide sequence.-   19. A ligand that binds a human TOI comprising an amino acid    sequence encoded by a TOI nucleotide sequence having a cumulative    human allele frequency of less than 50% and/or a total human    genotype frequency of less than 50%, for use in a method comprising    the step of using the ligand to target said TOI in a human to treat    and/or prevent a disease or condition mediated by TOI, the method    comprising administering the ligand to the human.-   20. The ligand of any one of paragraphs 17 to 19, wherein the human    has been or is genotyped as positive for said TOI nucleotide    sequence having a cumulative human allele frequency of less than    50%.    -   The ligand of any one of paragraphs 17 to 19, wherein the human        has been or is genotyped as positive for said TOI nucleotide        sequence having a total human genotype frequency of less than        50%.-   21. The ligand of any one of paragraphs 17 to 20, wherein the human    has been or is phenotyped as positive for a TOI encoded by a    nucleotide sequence having a cumulative human allele frequency of    less than 50% and/or having a total human genotype frequency of less    than 50%.-   22. The ligand of any one of paragraphs 17 to 21, wherein the human    has been or is genotyped as heterozygous for a TOI nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or having a total human genotype frequency of less than 50%;    optionally wherein the human has been or is genotyped as comprising    a TOI nucleotide sequence having a cumulative human allele frequency    of less than 50% and a TOI nucleotide sequence having a cumulative    human allele frequency of more than 50% and/or having a total human    genotype frequency of more than 50%.-   23. The ligand of any one of paragraphs 17 to 22, wherein the genome    of the human has been or is genotyped as homozygous for a TOI    nucleotide sequence having a cumulative human allele frequency of    less than 50% and/or having a total human genotype frequency of less    than 50%.-   24. The ligand of any one of paragraphs 17 to 23, wherein the ligand    comprises an antibody binding site that binds a human TOI comprising    an amino acid sequence encoded by a TOI nucleotide sequence having a    cumulative human allele frequency of less than 50% and/or having a    total human genotype frequency of less than 50%; and optionally has    been or is determined as capable of such binding.-   25. The ligand of paragraph 24, wherein the ligand is an antibody or    antibody fragment.-   26. The ligand of any one of paragraphs 17 to 23, wherein the ligand    comprises a nucleotide sequence that specifically hybridises to a    TOI nucleotide sequence having a cumulative human allele frequency    of less than 50% and/or having a total human genotype frequency of    less than 50% or an RNA transcript thereof; and/or the ligand    comprises a nucleotide sequence that comprises at least 10    contiguous nucleotides of a nucleotide sequence having a cumulative    human allele frequency of less than 50% and/or having a total human    genotype frequency of less than 50% or is an antisense sequence    thereof.-   27. The ligand of any one of paragraphs 17 to 26, wherein the genome    of said human comprises a nucleotide sequence having a cumulative    human allele frequency of less than 50% and the sequence is found in    at least 2 different ethnic populations.-   28. A pharmaceutical composition or kit for treating or preventing a    condition or disease mediated by a TOI as recited in any preceding    paragraph, the composition or kit comprising a ligand of any one of    paragraphs 17 to 27; and optionally in combination with a label or    instructions for use to treat and/or prevent said disease or    condition in a human; optionally wherein the label or instructions    comprise a marketing authorisation number (eg, an FDA or EMA    authorisation number); optionally wherein the kit comprises an    injection pen or IV container that comprises the ligand.-   29. A method of producing an anti-human TOI antibody binding site,    the method comprising obtaining a plurality of anti-TOI antibody    binding sites, screening the antibody binding sites for binding to a    TOI comprising an amino acid sequence encoded by a nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or a total human genotype frequency of less than 50%, or to a    peptide thereof that comprises an amino acid variation from the    corresponding sequence encoded by the TOI-encoding nucleotide    sequence having the highest cumulative human allele frequency and/or    the highest total human genotype frequency, and isolating an    antibody binding site that binds in the screening step.-   30. A method of producing an anti-human TOI antibody, the method    comprising immunising a non-human vertebrate (eg, a mouse or a rat)    with a TOI comprising an amino acid sequence encoded by a nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or a total human genotype frequency of less than 50%, or to a    peptide thereof that comprises an amino acid variation from the    corresponding sequence encoded by the TOI-encoding nucleotide    sequence having the highest cumulative human allele frequency and/or    the highest total human genotype frequency, and isolating an    antibody that binds a TOI comprising an amino acid sequence encoded    by a TOI nucleotide sequence having a cumulative human allele    frequency of less than 50% and/or a total human genotype frequency    of less than 50%, and optionally producing a TOI-binding fragment or    derivative of the isolated antibody.-   31. The method of paragraph 29 or 30, comprising the step of    obtaining a nucleic acid encoding the antibody, fragment, derivative    or binding site and optionally inserting the nucleic acid in an    expression vector.-   32. A kit for TOI genotyping a human, wherein the kit comprises a    nucleic acid comprising a nucleotide sequence that specifically    hybridises to a TOI nucleotide sequence selected having a cumulative    human allele frequency of less than 50% and/or a total human    genotype frequency of less than 50% or an RNA transcript thereof    and/or the nucleic acid comprises a nucleotide sequence that    comprises at least 10 contiguous nucleotides of a TOI nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or a total human genotype frequency of less than 50% or is an    antisense sequence thereof.-   33. A kit for TOI genotyping or phenotyping a human, wherein the kit    comprises a ligand according to any one of paragraphs 17 to 27 or an    antibody, fragment or derivative produced by the method of any one    of paragraphs 29 to 31.-   34. Use of an anti-TOI ligand that binds a human TOI comprising an    amino acid sequence encoded by a TOI nucleotide sequence having a    cumulative human allele frequency of less than 50% and/or a total    human genotype frequency of less than 50%, in the manufacture of a    medicament for treating and/or preventing a TOI-mediated disease or    condition in a human whose genome comprises a TOI nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or having a total human genotype frequency of less than 50%.-   35. Use of an anti-TOI ligand that binds a human TOI comprising an    amino acid sequence encoded by a TOI nucleotide sequence having a    cumulative human allele frequency of less than 50% and/or a total    human genotype frequency of less than 50%, in the manufacture of a    medicament for targeting said TOI in a human to treat and/or prevent    a disease or condition mediated by TOI.-   36. A method of targeting a TOI for treating and/or preventing a    TOI-mediated disease or condition in a human, the method comprising    administering an anti-TOI ligand to a human comprising a TOI    nucleotide sequence selected having a cumulative human allele    frequency of less than 50% and/or a total human genotype frequency    of less than 50%, whereby a TOI encoded by said nucleotide sequence    is targeted.-   37. The method of paragraph 36, wherein the method comprises    targeting a human TOI comprising an amino acid sequence with said    ligand to treat and/or prevent said disease or condition in said    human, wherein said amino acid sequence is encoded by a nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or a total human genotype frequency of less than 50%.-   38. A method of TOI genotyping a nucleic acid sample of a human, the    method comprising identifying in the sample the presence of a TOI    nucleotide sequence having a cumulative human allele frequency of    less than 50% and/or having a total human genotype frequency of less    than 50%.-   39. A method of TOI typing a protein sample of a human, the method    comprising identifying in the sample the presence of a TOI amino    acid sequence encoded by a TOI nucleotide sequence having a    cumulative human allele frequency of less than 50% and/or having a    total human genotype frequency of less than 50%.-   40. The method of paragraph 38 or 39, comprising obtaining a sample    of serum, blood, faeces, hair, urine or saliva from a human, whereby    the nucleic acid or protein sample is obtained for use in the step    of identifying said sequence.-   41. The method of any one of paragraphs 38 to 40, comprising using a    ligand according to any one of paragraphs 17 to 27 to carry out said    identifying step.-   42. A diagnostic kit comprising a ligand that is capable of binding    a human TOI comprising an amino acid sequence encoded by a TOI    nucleotide sequence having a cumulative human allele frequency of    less than 50% and/or a total human genotype frequency of less than    50% and instructions for carrying out the method of paragraph 38 or    39.-   43. A diagnostic kit comprising a nucleic acid probe comprising a    nucleotide sequence that specifically hybridises a TOI nucleotide    sequence having a cumulative human allele frequency of less than 50%    and/or a total human genotype frequency of less than 50% or an RNA    transcript thereof and instructions for carrying out the method of    paragraph 38 or 39.-   44. The method, ligand, composition, kit or use of any preceding    paragraph, wherein the TOI is encoded by a nucleotide sequence    having a cumulative human allele frequency from 1 to 10% and/or a    total human genotype frequency from 1 to about 15% or from 1 to 15%.-   45. The method, ligand, composition, kit or use of any preceding    paragraph wherein the TOI is a human TOI selected from Table 5;    optionally for treating and/or preventing a corresponding disease or    condition as set out in table 5.-   46. The ligand, method, use, kit or composition of any preceding    paragraph, wherein    -   (i) the ligand (eg, antibody or fragment) comprises        -   (e) a variable domain that is encoded by a human V region            nucleotide sequence, wherein the V nucleotide sequence is            derived from recombination of human VH, D and JH gene            segments or human VL and JL gene segments; or        -   (f) a constant region domain encoded by a C region gene            segment;        -   Wherein a first gene segment of said gene segments of (a),            or said C region gene segment of        -   (b) comprises a first single nucleotide polymorphism (SNP)            encoding a first amino acid polymorphism; and    -   (ii) the genome of said human comprises said first SNP or        wherein said human expresses (a′) an antibody variable domain        comprising said first amino acid polymorphism or (b′) an        antibody constant domain comprising said first amino acid        polymorphism.-   47. The ligand, method, use, kit or composition of paragraph 46,    wherein blood of said human comprises substantially no antibodies    that specifically bind to the domain comprising said first amino    acid polymorphism as determined in an in vitro binding assay.-   48. The ligand, method, use, kit or composition of paragraph 47,    wherein SPR is used to carry out said assay.-   49. The ligand, method, use, kit or composition of any one of    paragraphs 46 to 48, wherein the genome of said human comprises said    first gene segment (when (a) applies) or said C region gene segment    (when (b) applies).-   50. The ligand, method, use, kit or composition of any one of    paragraphs 46 to 49, wherein said first segment or a second segment    of said segments of (a), or said C region gene segment of (b),    comprises a second SNP encoding a second amino acid polymorphism;    and wherein the genome of said human comprises said second SNP or    wherein said human expresses (a″) an antibody variable domain    comprising said second amino acid polymorphism or (b″) an antibody    constant region domain comprising said first and second amino acid    polymorphisms.-   51. The ligand, method, use, kit or composition of paragraph 50,    wherein said human expresses an antibody variable domain comprising    said first and second amino acid polymorphisms.-   52. The ligand, method, use, kit or composition of paragraph 50 or    51, wherein the first and second SNPs of said genome are comprised    by the same antibody gene segment.-   53. The ligand, method, use, kit or composition of any one of    paragraphs 46 to 52, wherein each SNP is a variable region gene    segment SNP.-   54. The ligand, method, use, kit or composition of any one of    paragraphs 46 to 52, wherein each SNP is a constant region gene    segment SNP, eg each SNP is a gamma-1 constant region gene segment    SNP, or a gamma-2 constant region gene segment SNP, or a gamma-3    constant region gene segment SNP or a gamma-4 constant region gene    segment SNP.-   55. The ligand, method, use, kit or composition of paragraph 54,    wherein the first SNP is a CH1, CH2, CH3 or CH4 gene segment SNP    and/or the second SNP is a CH1, CH2, CH3 or CH4 gene segment SNP.-   56. The ligand, method, use, kit or composition of any one of    paragraphs 46 to 53, wherein each SNP is a variable domain SNP, eg,    a VH domain SNP, or a Vκ domain SNP, or a Vλ SNP.-   57. The ligand, method, use, kit or composition of any one of    paragraphs 46 to 56, wherein said constant region domain of (b) is    comprised by an antibody Fc region.-   58. The ligand, method, use, kit or composition of any one of    paragraphs 46 to 57, wherein the ligand (eg, antibody or fragment)    has been determined to specifically bind one or more human TOI    variants as disclosed herein, for example, with a KD of 1 nM or less    (eg, 100 or 10 pM or less) as determined by SPR.-   59. The ligand, method, use, kit or composition of any preceding    paragraph (eg, according to any one of paragraphs 46 to 58), wherein    the ligand comprises or consists of an antibody or fragment that    comprises a human antibody variable domain derived from the    recombination of a human V gene segment and a human J gene segment    (and optionally a human D gene segment when the variable domains are    VH domains); and wherein the genome of the human comprises said    human V gene segment and/or the human expresses antibodies    comprising antibody variable domains derived from the recombination    of said human V gene segment and a human J gene segment (and    optionally a human D gene segment).-   60. The ligand, method, use, kit or composition of any preceding    paragraph (eg, according to any one of paragraphs 46 to 59), wherein    the ligand (eg, comprising or consisting of an antibody or fragment    or an Fc-fused human TOI receptor) comprises a human heavy chain    constant domain encoded by a first constant region nucleotide    sequence; and wherein the genome of the human comprises a heavy    chain constant region nucleotide sequence that is identical to said    first constant region nucleotide sequence and/or the human expresses    antibodies comprising said human constant domain.-   61. The ligand, method, use, kit or composition of any preceding    paragraph (eg, according to any one of paragraphs 46 to 60), wherein    the ligand (eg, comprising or consisting of an antibody or fragment    or an Fc-fused human TOI receptor) comprises a human gamma heavy    chain CH1 domain encoded by a CH1 nucleotide sequence; and wherein    the genome of the human comprises a gamma heavy chain constant    region nucleotide sequence that is identical to said CH1 nucleotide    sequence and/or the human expresses antibodies comprising said human    gamma CH1 domain.-   62. The ligand, method, use, kit or composition of any preceding    paragraph (eg, according to any one of paragraphs 46 to 61), wherein    the ligand (eg, comprising or consisting of an antibody or fragment    or an Fc-fused human TOI receptor) comprises a human gamma heavy    chain CH2 domain encoded by a CH2 nucleotide sequence; and wherein    the genome of the human comprises a gamma heavy chain constant    region nucleotide sequence that is identical to said CH2 nucleotide    sequence and/or the human expresses antibodies comprising said human    gamma CH2 domain.-   63. The ligand, method, use, kit or composition of any preceding    paragraph (eg, according to any one of paragraphs 46 to 62),    wherein, wherein the ligand (eg, comprising or consisting of an    antibody or fragment or an Fc-fused human TOI receptor) comprises a    human gamma heavy chain CH3 domain encoded by a CH3 nucleotide    sequence; and wherein the genome of the human comprises a gamma    heavy chain constant region nucleotide sequence that is identical to    said CH3 nucleotide sequence and/or the human expresses antibodies    comprising said human gamma CH3 domain.-   64. The ligand, method, use, kit or composition of any preceding    paragraph (eg, according to any one of paragraphs 46 to 63), wherein    the ligand (eg, comprising or consisting of an antibody or fragment    or an Fc-fused human TOI receptor) comprises a human gamma heavy    chain CH4 domain encoded by a CH4 nucleotide sequence; and wherein    the genome of the human comprises a gamma heavy chain constant    region nucleotide sequence that is identical to said CH4 nucleotide    sequence and/or the human expresses antibodies comprising said human    gamma CH4 domain.-   65. The ligand, method, use, kit or composition of any preceding    paragraph (eg, according to any one of paragraphs 46 to 64), wherein    the ligand (eg, comprising or consisting of an antibody or fragment    or an Fc-fused human TOI receptor) comprises a human gamma heavy    chain Fc region encoded by a Fc nucleotide sequence; and wherein the    genome of the human comprises a gamma heavy chain constant region    nucleotide sequence that is identical to said Fc nucleotide sequence    and/or the human expresses antibodies comprising said human gamma Fc    region.-   66. The ligand, method, use, kit or composition of any one of    paragraphs 61 to 65, wherein said human gamma heavy chain is a human    gamma-1 heavy chain.-   67. The ligand, method, use, kit or composition of any one of    paragraphs 61 to 65, wherein said human gamma heavy chain is a human    gamma-2 heavy chain.-   68. The ligand, method, use, kit or composition of any one of    paragraphs 61 to 65, wherein ligand comprises a human IGHG1*01    gamma-1 heavy chain constant region.-   69. The ligand, method, use, kit or composition of any one of    paragraphs 61 to 65, wherein ligand comprises a human IGHG2*01    gamma-1 heavy chain constant region.-   70. The ligand, method, use, kit or composition of any one of    paragraphs 60 to 69, wherein the human has been or is genotyped as    positive for said heavy chain constant region nucleotide sequence.-   71. The ligand, method, use, kit or composition of paragraph 68,    wherein the human has been or is genotyped as positive for human    IGHG1*01 nucleotide sequence.-   72. The ligand, method, use, kit or composition of paragraph 69,    wherein the human has been or is genotyped as positive for human    IGHG2*01 nucleotide sequence.-   73. The ligand, method, use, kit or composition of any one of    paragraphs 61 to 69, wherein the human has been or is phenotyped as    positive for said gamma heavy chain constant domain, CH1, CH2, CH3,    CH4 or Fc.-   74. The ligand, method, use, kit or composition of paragraph 63, (i)    when dependent from clause 23, wherein the human has been or is    phenotyped as positive for a human IGHG1*01 gamma heavy chain    constant domain, CH1, CH2, CH3, CH4 or Fc or (ii) when dependent    from clause 24, wherein the human has been phenotyped as positive    for a human IGHG2*01 gamma heavy chain constant domain, CH1, CH2,    CH3, CH4 or Fc.-   75. The method or use of any one of paragraphs 61 to 69 and 71 to    74, comprising genotyping the human as positive for said gamma heavy    chain constant region nucleotide sequence, eg, positive for said    gamma heavy chain constant domain, CH1, CH2, CH3, CH4 or Fc    nucleotide sequence; positive for said human IGHG1*01 gamma heavy    chain constant region, CH1, CH2, CH3, CH4 or Fc nucleotide sequence;    or positive for said human IGHG2*01 gamma heavy chain constant    region, CH1, CH2, CH3, CH4 or Fc nucleotide sequence.-   76. The method or use of any one of paragraphs 61 to 69 and 71 to    75, comprising phenotyping the human as positive for said gamma    heavy chain constant region, eg, positive for said gamma heavy chain    constant domain, CH1, CH2, CH3, CH4 or Fc; positive for said human    IGHG1*01 gamma heavy chain constant domain, CH1, CH2, CH3, CH4 or    Fc; or positive for said human IGHG2*01 gamma heavy chain constant    domain, CH1, CH2, CH3, CH4 or Fc.-   77. The ligand, method, use, kit or composition of any preceding    paragraph (eg, according to any one of clauses 46 to 76), wherein    the ligand (eg, comprising or consisting of an antibody or fragment    or an Fc-fused TOI receptor) comprises a human gamma-1 heavy chain    constant region that comprises an Asp corresponding to position 204    of SEQ ID NO: 42 or a Leu corresponding to position 206 of SEQ ID    NO: 42 and wherein the genome of the human comprises a gamma-1 heavy    chain constant region nucleotide sequence that encodes such an Asp    or Leu or the human expresses antibodies comprising human gamma-1    constant regions comprising such an Asp or Leu.-   78. The ligand, method, use, kit or composition of paragraph 77,    wherein the ligand comprises a human gamma-1 heavy chain constant    region that comprises an Asp corresponding to position 204 of SEQ ID    NO: 42 and a Leu corresponding to position 206 of SEQ ID NO: 42.-   79. The ligand, method, use, kit or composition of paragraph 77 or    78, wherein the genome of the human comprises a gamma-1 heavy chain    constant region nucleotide sequence that encodes such an Asp and Leu    or the human expresses antibodies comprising human gamma-1 constant    regions comprising such an Asp and Leu.-   80. The ligand, method, use, kit or composition of paragraph 77, 78    or 79, wherein the ligand comprises a human IGHG1*01 gamma-1 heavy    chain constant region, eg, an Fc, CH1, CH2 and/or CH3 domain encoded    by human IGHG1*01.-   81. The ligand, method, use, kit or composition of any one of    paragraphs 77 to 80, wherein the genome of the human comprises a    human IGHG1*01 nucleotide sequence or the human expresses antibodies    comprising human constant domains encoded by a human IGHG1*01    nucleotide sequence.-   82. The ligand, method, use, kit or composition of any one of    paragraphs 77 to 81, wherein the ligand comprises a hinge region    encoded by human IGHG1*01.-   83. The ligand, method, use, kit or composition of any one of    paragraphs 77 to 82, wherein the ligand comprises or consists of an    antibody, wherein the antibody comprises heavy chains that comprise    SEQ ID NO: 61.-   84. The ligand, method, use, kit or composition of any one of    paragraphs 77 to 83, wherein the human is of European ancestry.-   85. The ligand, method, use, kit or composition of any one of    paragraphs 77 to 84, wherein the human has been or is genotyped as    positive for said Asp and/or Leu.-   86. The ligand, method, use, kit or composition of any one of    paragraphs 77 to 85, wherein the human has been or is genotyped as    positive for human IGHG1*01.-   87. The ligand, method, use, kit or composition of any one of    paragraphs 77 to 86, wherein the human has been or is phenotyped as    positive for a human IGHG1*01 CH3.-   88. The method or use of any one of paragraphs 77 to 87, comprising    selecting a said human whose genome comprises a codon(s) encoding    said Asp and/or Leu; comprises human IGHG1*01; or comprises a human    IGHG1*01 CH3.-   89. The method or use of any one of paragraphs 77 to 88, comprising    selecting a said human whose phenotype comprises said Asp and/or    Leu; a human IGHG1*01 region; or a human IGHG1*01 CH3.-   90. The ligand, method, use, kit or composition of any preceding    paragraph, wherein the ligand (eg, comprising or consisting of an    antibody or fragment or an Fc-fused TOI receptor) comprises a human    gamma-2 heavy chain constant region that comprises an amino acid    selected from the group consisting of a Pro corresponding to    position 72 of SEQ ID NO: 44, an Asn corresponding to position 75 of    SEQ ID NO: 44, a Phe corresponding to position 76 of SEQ ID NO: 44,    a Val corresponding to position 161 of SEQ ID NO: 44 and an Ala    corresponding to position 257 of SEQ ID NO: 44; and wherein the    genome of the human comprises a gamma-2 heavy chain constant region    nucleotide sequence that encodes such a selected amino acid or the    human expresses antibodies comprising human gamma-2 constant regions    comprising such a selected amino acid.-   91. The ligand, method, use, kit or composition of paragraph 90,    wherein the ligand comprises a human gamma-2 heavy chain constant    region that comprises (i) a Pro corresponding to position 72 of SEQ    ID NO: 44, an Asn corresponding to position 75 of SEQ ID NO: 44, a    Phe corresponding to position 76 of SEQ ID NO: 44 and    optionally (ii) a Val corresponding to position 161 of SEQ ID NO: 44    and/or an Ala corresponding to position 257 of SEQ ID NO: 44; and    wherein the genome of the human comprises a gamma-2 heavy chain    constant region nucleotide sequence that encodes such amino acids    of (i) or the human expresses antibodies comprising human gamma-2    constant regions comprising such amino acids of (i).-   92. The ligand, method, use, kit or composition of paragraph 90 or    91, wherein the ligand comprises a human gamma-2 heavy chain    constant region that comprises (i) a Val corresponding to position    161 of SEQ ID NO: 44 and an Ala corresponding to position 257 of SEQ    ID NO: 44 and optionally (ii) an amino acid selected from the group    consisting of a Pro corresponding to position 72 of SEQ ID NO: 44,    an Asn corresponding to position 75 of SEQ ID NO: 44 and a Phe    corresponding to position 76 of SEQ ID NO: 44; and wherein the    genome of the human comprises a gamma-2 heavy chain constant region    nucleotide sequence that encodes such amino acids of (i) or the    human expresses antibodies comprising human gamma-2 constant regions    comprising such amino acids of (i).-   93. The ligand, method, use, kit or composition of any one of    paragraph 90 to 92, wherein the ligand comprises a human IGHG2*01    gamma-2 heavy chain constant region, eg, an Fc, CH1, CH2 and/or CH3    domain encoded by human IGHG2*01.-   94. The ligand, method, use, kit or composition of any one of    paragraphs 90 to 93, wherein the genome of the human comprises a    human IGHG2*01 nucleotide sequence or the human expresses antibodies    comprising human constant domains encoded by a human IGHG2*01    nucleotide sequence.-   95. The ligand, method, use, kit or composition of any one of    paragraphs 90 to 94, wherein the ligand comprises a hinge region    encoded by human IGHG2*01.-   96. The ligand, method, use, kit or composition of any one of    paragraphs 90 to 95, wherein the ligand comprises or consists of an    antibody, wherein the antibody comprises heavy chains that comprise    SEQ ID NO: 63 or 65.-   97. The ligand, method, use, kit or composition of any one of    paragraphs 90 to 96, wherein the human is of European, African    American, or European American ancestry.-   98. The ligand, method, use, kit or composition of any one of    paragraphs 90 to 97, wherein the human has been or is genotyped as    positive for one, more or all of said Pro, Asn, Phe, Val and Ala.-   99. The ligand, method, use, kit or composition of any one of    paragraphs 90 to 98, wherein the human has been or is genotyped as    positive for human IGHG2*01.-   100. The ligand, method, use, kit or composition of any one of    paragraphs 90 to 99, wherein the human has been or is phenotyped as    positive for a human IGHG2*01 CH1.-   101. The ligand, method, use, kit or composition of any one of    paragraphs 90 to 100, wherein the human has been or is phenotyped as    positive for a human IGHG2*01 CH2.-   102. The ligand, method, use, kit or composition of any one of    paragraphs 90 to 101, wherein the human has been or is phenotyped as    positive for a human IGHG2*01 CH3.-   103. The method or use of any one of paragraphs 90 to 102,    comprising selecting a said human whose genome comprises a codon(s)    encoding one, more or all of said Pro, Asn, Phe, Val and Ala;    comprises human IGHG2*01; or comprises a human IGHG2*01 CH1, CH2    and/or CH3.-   104. The method or use of any one of paragraphs 90 to 103,    comprising selecting a said human whose phenotype comprises one,    more or all of said Pro, Asn, Phe, Val and Ala; a human IGHG2*01    region; or a human IGHG2*01 CH1, CH2 and/or CH3.-   105. The ligand, method, use, kit or composition of any one of    paragraphs 90 to 104, wherein the human expresses antibodies    comprising human gamma-2 constant regions comprising such a Pro,    Asn, Phe, Val and Ala.-   106. The ligand, method, use, kit or composition of any preceding    paragraph, wherein the ligand (eg, comprising or consisting of an    antibody or fragment or an Fc-fused TOI receptor) comprises a human    kappa light chain constant region that comprises a Val corresponding    to position 84 of SEQ ID NO: 50 or a Cys corresponding to position    87 of SEQ ID NO: 50; and wherein the genome of the human comprises a    kappa light chain constant region nucleotide sequence that encodes    such a Val or Cys or the human expresses antibodies comprising human    kappa light chain constant regions comprising such a Val or Cys.-   107. The ligand, method, use, kit or composition of paragraph 106,    wherein the ligand comprises a human kappa light chain constant    region that comprises a Val corresponding to position 84 of SEQ ID    NO: 50 and a Cys corresponding to position 87 of SEQ ID NO: 50.-   108. The ligand, method, use, kit or composition of paragraph 106 or    107, wherein the genome of the human comprises a kappa light chain    constant region nucleotide sequence that encodes such a Val and Cys    or the human expresses antibodies comprising human kappa constant    regions comprising such a Val and Cys.-   109. The ligand, method, use, kit or composition of any one of    paragraphs 106 to 108, wherein the antibody or fragment comprises a    human IGKC*01 kappa light chain constant region.-   110. The ligand, method, use, kit or composition of any one of    paragraphs 106 to 109, wherein the ligand comprises or consists of    an antibody, wherein the antibody comprises light chains that    comprise SEQ ID NO: 62 or 66.-   111. The ligand, method, use, kit or composition of any one of    paragraphs 106 to 110, wherein the ligand comprises or consists of    an antibody, wherein the antibody comprises a light chain variable    domain derived from recombination of a human Vκ gene segment and a    human Jκ gene segment, wherein the Jκ gene segment is IGKJ2*01 (SEQ    ID NO: 57).-   112. The ligand, method, use, kit or composition of any one of    paragraphs 106 to 111, wherein the human has been or is phenotyped    as positive for said Val and/or Cys.-   113. The ligand, method, use, kit or composition of any one of    paragraphs 106 to 112, wherein the human has been or is genotyped as    positive for human IGKC*01.-   114. The ligand, method, use, kit or composition of any one of    paragraphs 106 to 113, wherein the human has been or is phenotyped    as positive for a human IGKC*01 domain.-   115. The method or use of any one of paragraphs 106 to 114,    comprising selecting a said human whose genome comprises a codon(s)    encoding said Val and/or Cys; or comprises human IGKC*01.-   116. The method or use of any one of paragraphs 106 to 115,    comprising selecting a said human whose phenotype comprises such a    Val and/or Cys; or comprises a human IGKC*01 domain.-   117. The ligand, method, use, kit or composition of any one of    paragraphs 106 to 116, wherein the human expresses antibodies    comprising human kappa constant domains comprising such a Val and    Cys, eg, expresses human IGKC*01 constant domains.-   118. The ligand, method, use, kit or composition of any preceding    paragraph, wherein the ligand (eg, comprising or consisting of an    antibody or fragment or an Fc-fused TOI receptor) comprises a human    IGLC2*01 light chain constant region; and wherein the genome of the    human comprises a human IGLC2*01 nucleotide sequence or the human    expresses antibodies comprising human light chain IGLC2*01 constant    regions.-   119. The ligand, method, use, kit or composition of paragraph 118,    wherein the antibody comprises light chains that comprise SEQ ID NO:    64.-   120. The ligand, method, use, kit or composition of paragraph 118 or    119, wherein the human has been or is genotyped as positive for    human IGLC2*01.-   121. The ligand, method, use, kit or composition of any one of    paragraphs 118 to 120, wherein the human has been or is phenotyped    as positive for a human IGLC2*01 domain.-   122. The method or use of any one of paragraphs 118 to 212,    comprising selecting a said human whose genome comprises human    IGLC2*01.-   123. The method or use of any one of clauses 73 to 77, comprising    selecting a said human whose phenotype comprises a human IGLC2*01    domain.-   124. The ligand, method, use, kit or composition of any one of    paragraphs 108 to 123, wherein the human expresses antibodies    comprising human lambda IGLC2*01 constant domains.-   125. The ligand, method, use, kit or composition of any preceding    paragraph, wherein the ligand comprises or consists of an antibody    or fragment, wherein the antibody or fragment comprises a VH domain    that is derived from the recombination of a human VH gene segment, a    human D gene segment and a human JH gene segment, wherein the VH    gene segment is selected from the group consisting of (i)    IGHV1-18*01 and the genome of the human comprises a human    IGHV1-18*01 nucleotide sequence or the human expresses antibodies    comprising variable domains derived from the recombination of human    IGHV1-18*01; or (ii) IGVH1-46*01 and the genome of the human    comprises a human IGHV1-46*01 nucleotide sequence or the human    expresses antibodies comprising variable domains derived from the    recombination of human IGHV1-46*01.-   126. The ligand, method, use, kit or composition of paragraph 125,    wherein the antibody or fragment comprises a one more or all of a    CH1 domain, CH2 domain, CH3 domain, hinge or Fc encoded by human    IGHG2*01.-   127. The ligand, method, use, kit or composition of paragraph 125 or    126, wherein the antibody or fragment comprises heavy chains that    comprise SEQ ID NO: 63 or 65.-   128. The ligand, method, use, kit or composition of any one of    paragraphs 125 to 127, wherein the human has been or is genotyped as    positive for said selected VH gene segment, positive for human    IGHV1-18*01 or IGVH1-46*01.-   129. The method or use of any of paragraphs 125 to 128, comprising    genotyping the human as positive for said selected VH gene segment,    eg, positive for human IGHV1-18*01 or IGVH1-46*01.-   130. The ligand, method, use, kit or composition any preceding    paragraph, wherein the ligand comprises or consists of an antibody    or fragment, wherein the antibody or fragment comprises a VL domain    that is derived from the recombination of a human VL gene segment    and a human JL gene segment, wherein the VL gene segment is selected    from the group consisting of (i) IGKV4-1*01 and the genome of the    human comprises a human IGKV4-1*01 nucleotide sequence or the human    expresses antibodies comprising variable domains derived from the    recombination of human IGKV4-1*01; (ii) IGLV2-14*01 and the genome    of the human comprises a human IGLV2-14*01 nucleotide sequence or    the human expresses antibodies comprising variable domains derived    from the recombination of human IGLV2-14*01; or (iii) IGKV1-13*02    and the genome of the human comprises a human IGKV1-13*02 nucleotide    sequence or the human expresses antibodies comprising variable    domains derived from the recombination of human IGKV1-13*02.-   131. The ligand, method, use, kit or composition of paragraph 130,    wherein the antibody comprises light chains that comprise SEQ ID NO:    62, 64 or 66.-   132. The ligand, method, use, kit or composition of paragraph 130 or    131, wherein the antibody or fragment comprises a light chain    variable domain derived from recombination of a human Vκ gene    segment and a human Jκ gene segment, wherein the Jκ gene segment is    IGKJ2*01 (SEQ ID NO: 57; wherein (i) or (iii) applies.-   133. The ligand, method, use, kit or composition of any one of    paragraphs 130 to 132, wherein the human has been or is genotyped as    positive for said selected VL gene segment, eg, positive for human    IGKV4-1*01, IGLV2-14*01 or IGKV1-13*02.-   134. The method or use of paragraph 133, comprising genotyping the    human as positive for said selected VL gene segment, eg, genotyping    the human as positive for human IGKV4-1*01, IGLV2-14*01 or    IGKV1-13*02.-   135. The ligand, method, use, kit or composition of any preceding    paragraph, wherein the ligand (eg, antibody or fragment) binds said    human TOI with a dissociation constant (Kd) of 1 nM or less as    determined by SPR, (eg, 100, 10 or 1pM or less).-   136. The ligand, method, use, kit or composition of any preceding    paragraph, wherein the TOI is human PCSK9 or human IL-6R.

EXAMPLES Example 1 Rare PCSK9 Variants

Proprotein convertase subtilisin kexin type 9 (PCSK9) is a serineprotease involved in regulating the levels of the low densitylipoprotein receptor (LDLR) protein (Horton et al., 2007; Seidah andPrat, 2007). In vitro experiments have shown that adding PCSK9 to HepG2cells lowers the levels of cell surface LDLR (Benjannet et al., 2004;Lagace et al., 2006; Maxwell et al., 2005; Park et al., 2004).Experiments with mice have shown that increasing PCSK9 protein levelsdecreases levels of LDLR protein in the liver (Benjannet et al., 2004;Lagace et al., 2006; Maxwell et al., 2005; Park et al., 2004), whilePCSK9 knockout mice have increased levels of LDLR in the liver (Rashidet al., 2005). Additionally, various human PCSK9 mutations that resultin either increased or decreased levels of plasma LDL have beenidentified (Kotowski et al., 2006; Zhao et al., 2006). PCSK9 has beenshown to directly interact with the LDLR protein, be endocytosed alongwith the LDLR, and co-immunofluoresce with the LDLR throughout theendosomal pathway (Lagace et al., 2006).

PCSK9 is a prohormone-proprotein convertase in the subtilisin (S8)family of serine proteases (Seidah et al., 2003). Humans have nineprohormone-proprotein convertases that can be divided between the S8Aand S8B subfamilies (Rawlings et al., 2006). Furin, PC1/PC3, PC2, PACE4,PC4, PC5/PC6 and PC7/PC8/LPC/SPC7 are classified in subfamily S8B.Crystal and NMR structures of different domains from mouse furin and PC1reveal subtilisin-like pro- and catalytic domains, and a P domaindirectly C-terminal to the catalytic domain (Henrich et al., 2003;Tangrea et al., 2002). Based on the amino acid sequence similaritywithin this subfamily, all seven members are predicted to have similarstructures (Henrich et al., 2005). SKI-1/S1P and PCSK9 are classified insubfamily SBA. Sequence comparisons with these proteins also suggest thepresence of subtilisin-like pro- and catalytic domains (Sakai et al.,1998; Seidah et al., 2003; Seidah et al., 1999). In these proteins theamino acid sequence C-terminal to the catalytic domain is more variableand does not suggest the presence of a P domain.

Prohormone-proprotein convertases are expressed as zymogens and theymature through a multi step process. The function of the pro-domain inthis process is two-fold. The pro-domain first acts as a chaperone andis required for proper folding of the catalytic domain (Ikemura et al.,1987). Once the catalytic domain is folded, autocatalysis occurs betweenthe pro-domain and catalytic domain. Following this initial cleavagereaction, the pro-domain remains bound to the catalytic domain where itthen acts as an inhibitor of catalytic activity (Fu et al., 2000). Whenconditions are correct, maturation proceeds with a second autocatalyticevent at a site within the pro-domain (Anderson et al., 1997). Afterthis second cleavage event occurs the pro-domain and catalytic domaindissociate, giving rise to an active protease.

Autocatalysis of the PCSK9 zymogen occurs between Gln152 and Ser153(VFAQ|SIP (SEQ ID NO: 116)) (Naureckiene et al., 2003), and has beenshown to be required for its secretion from cells (Seidah et al., 2003).A second autocatalytic event at a site within PCSK9's pro-domain has notbeen observed. Purified PCSK9 is made up of two species that can beseparated by non-reducing SDS-PAGE; the pro-domain at 17 Kd, and thecatalytic plus C-terminal domains at 65 Kd. PCSK9 has not been isolatedwithout its inhibitory pro-domain, and measurements of PCSK9's catalyticactivity have been variable (Naureckiene et al., 2003; Seidah et al.,2003).

In certain embodiments, a PCSK9 polypeptide includes terminal residues,such as, but not limited to, leader sequence residues, targetingresidues, amino terminal methionine residues, lysine residues, tagresidues and/or fusion protein residues. “PCSK9” has also been referredto as FH3, NARC1, HCHOLA3, proprotein convertase subtilisin/kexin type9, and neural apoptosis regulated convertase 1. The PCSK9 gene encodes aproprotein convertase protein that belongs to the proteinase K subfamilyof the secretory subtilase family. The term “PCSK9” denotes both theproprotein and the product generated following autocatalysis of theproprotein. When only the autocatalyzed product is being referred to(such as for an antigen binding protein or ligand that binds to thecleaved PCSK9), the protein can be referred to as the “mature,”“cleaved”, “processed” or “active” PCSK9. When only the inactive form isbeing referred to, the protein can be referred to as the “inactive”,“pro-form”, or “unprocessed” form of PCSK9. The term PCSK9 alsoencompasses PCSK9 molecules incorporating post-translationalmodifications of the PCSK9 amino acid sequence, such as PCSK9 sequencesthat have been glycosylated, PCSK9 sequences from which its signalsequence has been cleaved, PCSK9 sequence from which its pro domain hasbeen cleaved from the catalytic domain but not separated from thecatalytic domain (see, e.g., FIGS. 1A and 1B of US20120093818A1; whichis incorporated by reference herein in its entirety).

The present invention provides anti-PCSK9 ligands; and PCSK9-binding ortargeting ligands as described herein. The ligands have a variety ofutilities. Some of the ligands, for instance, are useful in specificbinding assays, for genotyping or phenotyping humans, affinitypurification of PCSK9, in particular human PCSK9 or its ligands and inscreening assays to identify other antagonists of PCSK9 activity. Someof the ligands of the invention are useful for inhibiting binding ofPCSK9 to LDLR, or inhibiting PCSK9-mediated activities.

Anti-PCSK9 ligands (eg, antibodies and anti-sense RNA) have beendeveloped based on targeting and neutralising so-called “wild-type”human PCSK9, which is a commonly-occurring form (see, eg,US20120093818A1 and US20110065902A1; each of which is incorporated byreference herein in its entirety). While such therapies are useful forhuman patients harbouring this form of human PCSK9, the inventorconsidered it useful to investigate the possibility of targeting muchrarer—but still naturally-occurring—forms of PCSK9 amongst humanpopulations. In this way, the inventor arrived at insight into thenatural occurrences and distributions of rarer human PCSK9 forms thatcan serve as useful targets (at the protein or nucleic acid level) forhuman treatment, prophylaxis and diagnosis pertinent to diseases andconditions mediated or associated with PCSK9 activity. This particularlyprovides for tailored therapies, prophylaxis and diagnosis in humansthat are devoid of the common PCSK9 gene or protein (ie, the form a ora′ as used in US20120093818A1 and US20110065902A1 to generateantibodies).

The skilled person will know that SNPs or other changes that translateinto amino acid variation can cause variability in activity and/orconformation of human targets to be addressed. This has spawned greatinterest in personalized medicine where genotyping and knowledge ofprotein and nucleotide variability is used to more effectively tailormedicines and diagnosis of patients. The invention, therefore, providesfor tailored pharmaceuticals and testing that specifically addressesrarer PCSK9 polymorphic variant forms. Such forms or “alleles” (at thenucleotide level), in many of the examples determined by the inventor,comprise multiple changes at the nucleotide and amino acid levels fromthe corresponding common form nucleotide and amino acids sequences, ie,there are multiple non-synonymous changes at the nucleotide level thattranslate into multiple corresponding changes in the protein target inhumans.

Furthermore, the inventor surprisingly realised that the rarer naturalforms, although present in humans at much lower frequencies than thecommon form, nevertheless are represented in multiple andethnically-diverse human populations and usually with many humanexamples per represented ethnic population. Thus, the inventor realisedthat targeting such rarer forms would provide for effective treatment,prophylaxis or diagnosis across many human ethnic populations, therebyextending the utility of the present invention.

With this realisation, the inventor realised that there is significantindustrial and medical application for the invention in terms of guidingthe choice of anti-PCSK9 ligand for administration to human patients fortherapy and/or prophylaxis of PCSK9-mediated or associated diseases orconditions. In this way, the patient receives drugs and ligands that aretailored to their needs—as determined by the patient's genetic orphenotypic makeup. Hand-in-hand with this, the invention provides forthe genotyping and/or phenotyping of patients in connection with suchtreatment, thereby allowing a proper match of drug to patient. Thisincreases the chances of medical efficacy, reduces the likelihood ofinferior treatment using drugs or ligands that are not matched to thepatient (eg, poor efficacy and/or side-effects) and avoidspharmaceutical mis-prescription and waste.

In developing this thinking, the present inventor decided to determine aset of human PCSK9 variants on the basis of the following criteria,these being criteria that the inventor realised would provide for usefulmedical drugs and diagnostics to tailored need in the human population.The inventor selected variants having at least 3 of the 4 followingcriteria:—

-   -   PCSK9 variants having a cumulative human allele frequency in the        range from 1 to 10%;    -   PCSK9 variants having a total human genotype frequency in the        range from 1 to about 15%;    -   PCSK9 variants found in many different human ethnic populations        (using the standard categorisation of the 1000 Genomes Project,        which is an accepted standard in the art; see Table 4 below);        and    -   PCSK9 variants found in many individuals distributed across such        many different ethnic populations.

On the basis of these criteria, the inventor identified the variantslisted in Table 1 below (excluding form a).

The inventor's selection included, as a consideration, selection fornucleotide variation that produced amino acid variation in correspondingPCSK9 forms (ie, non-synonymous variations), as opposed to silentvariations that do not alter amino acid residues in the target protein.

Human PCSK9 variants distributed over several human ethnic populations &having a total human genotype frequency in the range of 1 to about 15%(a) Amino acid variability, population distributions and frequenciesForm a 46R 53A 425N 443A 474I 619Q 670E ASW, YRI, GBR TSI, CLM, CHB, 93914 0.3951 0.4506 0.64815 LWK, CHS, MXL, JPT, PUR, IBS, (0.8457) FIN, CEUAmino Acid Position & Variation Variant Form 46L 53V 425S 443T 474V 619P670G Human Populations No. Individs¹ No. Unique Pops² Het Freq³ HomFreq⁴ (Het + Hom freq⁵) Cum Freq⁶ f x ASW, YRI, GBR TSI, CLM, LWK, 18012 0.153 0.0009 0.0855 MXL, JPT, PUR, IBS, FIN, CEU (0.162) c x ASW,YRI, GBR, TSI, CLM, CHB, 153 12 0.1296 0.0081 0.0729 LWK, CHS, JPT, PUR,IBS, FIN, CEU (0.1377) r x x 0.0234 0.009 0.0292 (0.0324) p x x ASW,GBR, TSI, CLM, JPT, PUR, 49 9 0.0441 (0.0441) 0.0221 IBS, FIN, CEU m xLWK, ASW, YRI, CLM 29 4 0.0225 (0.0255) 0.0149 e x x LWK, ASW, YRI 15 30.0135 (0.0135) 0.0068 h x x LWK, ASW, YRI 10 3 0.009 (0.009) 0.0045 ajX x PUR, TSI, FIN, CEU, 9 4 0.0081 (0.0081) 0.0041 q x x CHS, ASW, JPT,PUR, CHB 7 5 0.0063 (0.0063) 0.0032 Table Footnotes: “x” in a boxindicates that the amino acid for the variant form is different from theamino acid at that position in form a, the variant amino acid beingshown in “Amino Acid Position & Variation” of the table and the form aamino acid being shown in the first row of the table; amino acids at allother positions of each variant form are identical to those found inform a. Amino acid numbering is per the numbering shown for the pro-formin Table 2 below. 1. Number of individuals in 1000 Genomes databasefound to have the allele; 2. Number of unique human ethnic populationsin 1000 Genomes database in which the allele was found to occur; 3.Heterozygous human genotype frequency, ie, cumulative frequency of allgenotypes having one occurrence of the variant allele and one occurrenceof another allele (heterozygous state), eg, ac genotype in 1000 Genomesdatabase; 4. Homozygous human genotype frequency, ie, cumulativefrequency of two occurrences of the variant allele (homozygous state),eg, cc genotype in 1000 Genomes database; and 5. Total human genotypefrequency, ie, total of heterozygous plus homozygous human genotypefrequencies. 6. Cumulative human allele frequency of all occurrences ofthe variant allele in 1000 Genomes database. Form a′ is identical toform a with the exception that form a′ has a glycine (G) at position 620(see US20120093818 (Amgen, Inc)); form a has E at this position. (b)Nucleotide Sequence Variations of Selected Alleles Allele a G C A G A AA Nucleotide Position^(l) 1:55505647 1:55505668 1:55523802 1:555238551:55524237 1:55527222 1:55529187 Non-Synonymous Nucleotide Variation² TT G A G C G Variant ID³ rs11591147 rs11583680 rs28362261 rs28362263rs562556 rs28362277 rs505151 Variant Corresponding Amino Acid VariationAllele 46L 53V 425S 443T 474V 619P 670G f X c X r X X P X X m X e X X hX X aj X X q X X “x” in a box indicates that a variant allele comprisesthe non-synonymous nucleotide variation indicated in the 5th row. TableFootnotes: 1. Notation is chromosome number (all positions are on humanchromosome 1):coordinate number (Ensembl release 73 - September 2013,Genome assembly: GRCh37 (GCA_000001405.13); 2. Nucleotide change(compared to allele a nucleotide shown in first row) giving rise to anamino acid change in the variant form (compared to amino acid of allelea); and 3. NCBI dbSNP reference number (NCBI dbSNP Build 138 released onApr. 25, 2013).

TABLE 2 Sequences (a) Human PCSK9 Form a Amino Acid Sequence (SEQ IDNO: 1) - “Pro-form” with Signal Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

Italics = signal sequence 1-30

lower case = catalytic domain 153-449 UPPER CASE = C-terminal domain450-692 Underlined = residues changed from allele a in other sequences(aa residue number shown) The pro-form is the sequence from amino acidnumber 31 to (and including) amino acid number 692 of SEQ ID NO: 1. Themature form is the sequence from amino acid number 153 to (andincluding) amino acid number 692 of SEQ ID NO: 1. (b) Human PCSK9 Form aAmino Acid Sequence (SEQ ID NO: 3) - “Mature-form” (Numbering andnotation as per SEQ ID NO: 1 above has been retained)sipwnleritppryradayqppdggslvevylldtsiqsdhreiegrvmvtdfenvpeedgtrfhrqaskcdshgthlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqltvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

(c) Human PCSK9 Allele a Nucleotide Sequence (SEQ ID NO: 28) - Encoding“Pro-form” Plus Signal SequenceATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

GCCTCCCAGGAGCTCCAGTGAC Italics = nucleotide sequence encoding signalsequence (nucleotides 1-90)

lower case = nucleotide sequence encoding catalytic domain (nucleotides457-1346) UPPER CASE = nucleotide sequence encoding C-terminal domain(nucleotides 1347-2076) Underlined = allelic variations from allele a inother sequences (aa residue number changes and codon changes shown) Thepro-form is encoded by nucleotide sequence from nucleotide 91 to (andincluding) nucleotide 2076. The mature form is encoded by nucleotidesequence from nucleotide 457 to (and including) nucleotide 2076.

Variant Allele Nucleotide Sequences

Thus,

(i) The nucleotide sequence of allele f is identical to SEQ ID NO: 28except that the nucleotide sequence of allele f comprises a GTC codoninstead of an ATC codon at the position labelled “I474V” in SEQ ID NO:28;

(ii) The nucleotide sequence of allele c is identical to SEQ ID NO: 28except that the nucleotide sequence of allele c comprises a GGG codoninstead of an GAG codon at the position labelled “E670G” in SEQ ID NO:28;

(iii) The nucleotide sequence of allele r is identical to SEQ ID NO: 28except that the nucleotide sequence of allele r comprises a GTC codoninstead of an ATC codon at the position labelled “I474V” in SEQ ID NO:28; and a GGG codon instead of an GAG codon at the position labelled“E670G” in SEQ ID NO: 28;(iv) The nucleotide sequence of allele p is identical to SEQ ID NO: 28except that the nucleotide sequence of allele p comprises a GTC codoninstead of a GCC codon at the position labelled “A53V” in SEQ ID NO: 28;and a GTC codon instead of an ATC codon at the position labelled “I474V”in SEQ ID NO: 28;(v) The nucleotide sequence of allele m is identical to SEQ ID NO: 28except that the nucleotide sequence of allele m comprises a ACC codoninstead of a GCC codon at the position labelled “A443T” in SEQ ID NO:28;(vi) The nucleotide sequence of allele e is identical to SEQ ID NO: 28except that the nucleotide sequence of allele e comprises a AGT codoninstead of an AAT codon at the position labelled “N425S” in SEQ ID NO:28; and a GTC codon instead of an ATC codon at the position labelled“I474V” in SEQ ID NO: 28;(vii) The nucleotide sequence of allele h is identical to SEQ ID NO: 28except that the nucleotide sequence of allele h comprises a ACC codoninstead of a GCC codon at the position labelled “A443T” in SEQ ID NO:28; and a CCG codon instead of a CAG codon at the position labelled“Q619P” in SEQ ID NO: 28;(viii) The nucleotide sequence of allele aj is identical to SEQ ID NO:28 except that the nucleotide sequence of allele aj comprises a CTTcodon instead of an CGT codon at the position labelled “R46L” in SEQ IDNO: 28; and a GTC codon instead of an ATC codon at the position labelled“I474V” in SEQ ID NO: 28; and(ix) The nucleotide sequence of allele q is identical to SEQ ID NO: 28except that the nucleotide sequence of allele q comprises a GTC codoninstead of a GCC codon at the position labelled “A53V” in SEQ ID NO: 28;and a GGG codon instead of an GAG codon at the position labelled “E670G”in SEQ ID NO: 28.

Variant Pro-Form Amino Acid Sequences

(Numbering is as Per SEQ ID NO: 1 Recited Above)

(A) The amino acid sequence of form f is identical to the amino acidsequence from amino acid number 31 to (and including) amino acid number692 of SEQ ID NO: 1 except that the amino acid sequence of form fcomprises a valine at position 474;

(B) The amino acid sequence of form c is identical to the amino acidsequence from amino acid number 31 to (and including) amino acid number692 of SEQ ID NO: 1 except that the amino acid sequence of form ccomprises a glycine at position 670;

(C) The amino acid sequence of form r is identical to the amino acidsequence from amino acid number 31 to (and including) amino acid number692 of SEQ ID NO: 1 except that the amino acid sequence of form rcomprises a valine at position 474 and a glycine at position 670;(D) The amino acid sequence of form p is identical the amino acidsequence from amino acid number 31 to (and including) amino acid number692 of SEQ ID NO: 1 except that the amino acid sequence of form pcomprises a valine at position 53 and a valine at position 474;(E) The amino acid sequence of form m is identical to the amino acidsequence from amino acid number 31 to (and including) amino acid number692 of SEQ ID NO: 1 except that the amino acid sequence of form mcomprises a threonine at position 443;(F) The amino acid sequence of form e is identical to the amino acidsequence from amino acid number 31 to (and including) amino acid number692 of SEQ ID NO: 1 except that the amino acid sequence of form ecomprises a serine at position 425 and a valine at position 474;(G) The amino acid sequence of form h is identical to the amino acidsequence from amino acid number 31 to (and including) amino acid number692 of SEQ ID NO: 1 except that the amino acid sequence of form hcomprises a threonine at position 443 and a proline at position 619;(H) The amino acid sequence of form aj is identical to the amino acidsequence from amino acid number 31 to (and including) amino acid number692 of SEQ ID NO: 1 except that the amino acid sequence of form ajcomprises a leucine at position 46 and a valine at position 474; and(I) The amino acid sequence of form q is identical to the amino acidsequence from amino acid number 31 to (and including) amino acid number692 of SEQ ID NO: 1 except that the amino acid sequence of form qcomprises a valine at position 53 and a glycine at position 670.

Variant Mature Form Amino Acid Sequences

(Numbering is as Per SEQ ID NO: 1 Recited Above)

(A′) The amino acid sequence of form f is identical to SEQ ID NO: 2except that the amino acid sequence of form f comprises a valine atposition 474;

(B′) The amino acid sequence of form c is identical to SEQ ID NO: 2except that the amino acid sequence of form c comprises a glycine atposition 670;

(C′) The amino acid sequence of form r is identical to SEQ ID NO: 2except that the amino acid sequence of form r comprises a valine atposition 474 and a glycine at position 670;

(D′) The amino acid sequence of form p is identical to SEQ ID NO: 2except that the amino acid sequence of form p comprises a valine atposition 474;

(E′) The amino acid sequence of form m is identical to SEQ ID NO: 2except that the amino acid sequence of form m comprises a threonine atposition 443;

(F′) The amino acid sequence of form e is identical to SEQ ID NO: 2except that the amino acid sequence of form e comprises a serine atposition 425 and a valine at position 474;

(G′) The amino acid sequence of form h is identical to SEQ ID NO: 2except that the amino acid sequence of form h comprises a threonine atposition 443 and a proline at position 619;

(H′) The amino acid sequence of form aj is identical to SEQ ID NO: 2except that the amino acid sequence of form aj comprises valine atposition 474; and

(I′) The amino acid sequence of form q is identical to SEQ ID NO: 2except that the amino acid sequence of form q comprises a glycine atposition 670.

The mature form of p is identical to the mature form off and aj.

The mature form of c is identical to the mature form of q.

Further sequence analysis and 3D in silico modelling (see FIG. 1)revealed that selected variants also fulfilled the following selectioncriteria:—

-   -   PCSK9 variants whose variant amino acid residues (versus the        common form of human PCSK9) are found in the mature form of the        target (ie, outside the pro-domain); and    -   PCSK9 variants whose variant amino acid residues (versus the        common form of human PCSK9) are surface-exposed on the target,        which the inventor saw as contributing to determining the        topography of the target and potentially contributing to how and        where ligand binding on the target occurs.

As shown in FIG. 1, identified positions 425, 443, 474, 619 and 670(found in the selected variants of the invention) are allsurface-exposed and outside of the pro-domain. Variant positions 425 and443 are surface-exposed on the catalytic domain, while variant positions474, 619 and 670 are surface-exposed on the C-terminal domain.

In a first example, the invention addresses the need to treat humanshaving naturally-occurring rarer natural PCSK9 alleles, genotypes andphenotypes (rarer protein forms). In this respect, the inventionprovides the following aspects:

In a First Aspect:

An anti-human PCSK9 ligand for use in a method of treating and/orpreventing a PCSK9-mediated disease or condition in a human whose genomecomprises a nucleotide sequence selected from the group consisting ofSEQ ID NOs: 29-37, wherein the method comprises administering the ligandto the human.

In an example, the nucleotide sequence is selected from the groupconsisting of SEQ ID NOs: 29-35 and 37; or selected from the groupconsisting of SEQ ID NOs: 29-32 and 34-37; or selected from the groupconsisting of SEQ ID NOs: 29-32, 34, 35 and 37. These arenaturally-occurring allele (haplotype) sequences that do not encode 46Land which meet the criteria set out above. These groups comprisevariants that are associated with elevated LDL-C.

In an example, the nucleotide sequence is SEQ ID NO: 34, that encodes a425S, which is associated with elevated LDL-C (Pisciotta et al 2006).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31 and 37, that encode 670G which is a markerfor severity of coronary atherosclerosis (Chen et al 2005).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31, 32, 34, 35, 36 and 37; or selected fromthe group consisting of SEQ ID NOs: 31, 32, 34, 35 and 37. These areallele (haplotype) sequences that have a naturally-occurring combinationof differences from SEQ ID NO: 28 (form a) and which meet the criteriaset out above.

In an example, the nucleotide sequence is SEQ ID NO: 29.

In an example, the nucleotide sequence is SEQ ID NO: 30.

In an example, the nucleotide sequence is SEQ ID NO: 31.

In an example, the nucleotide sequence is SEQ ID NO: 32.

In an example, the nucleotide sequence is SEQ ID NO: 33.

In an example, the nucleotide sequence is SEQ ID NO: 34.

In an example, the nucleotide sequence is SEQ ID NO: 35.

In an example, the nucleotide sequence is SEQ ID NO: 36.

In an example, the nucleotide sequence is SEQ ID NO: 37.

In the alternative the nucleotide sequence encodes a human PCSK9comprising a mutation R46L, A53V, N425S, A443T, I474V, Q619P and E670G(eg, comprises a mutation I474, E670G, N425S or Q619P) in SEQ ID NO: 1;for example, the PCSK9 comprises I474V in SEQ ID NO: 1 and optionallythe human comprises such a PCSK9 or a nucleotide sequence encoding sucha PCSK9 (eg, wherein the method is for treating or preventingdislipidemia, eg reducing cholesterol or maintaining reduced cholesterolin the human); for example, the PCSK9 comprises E670G in SEQ ID NO: 1and optionally the human comprises such a PCSK9 or a nucleotide sequenceencoding such a PCSK9 (eg, wherein the method is for treating orpreventing dislipidemia, eg reducing cholesterol or maintaining reducedcholesterol in the human); for example, the PCSK9 comprises Q619P in SEQID NO: 1 and optionally the human comprises such a PCSK9 or a nucleotidesequence encoding such a PCSK9 (eg, wherein the method is for treatingor preventing dislipidemia, eg reducing cholesterol or maintainingreduced cholesterol in the human); for example, the PCSK9 comprisesN425S in SEQ ID NO: 1 and optionally the human comprises such a PCSK9 ora nucleotide sequence encoding such a PCSK9 (eg, wherein the method isfor treating or preventing dislipidemia, eg reducing cholesterol ormaintaining reduced cholesterol in the human); for example, the PCSK9comprises R46L in SEQ ID NO: 1 and optionally the human comprises such aPCSK9 or a nucleotide sequence encoding such a PCSK9 (eg, wherein themethod is for treating or preventing dislipidemia, eg increasingcholesterol in the human); for example, the PCSK9 comprises A53V in SEQID NO: 1 and optionally the human comprises such a PCSK9 or a nucleotidesequence encoding such a PCSK9 (eg, wherein the method is for treatingor preventing dislipidemia, eg increasing cholesterol in the human); forexample, the PCSK9 comprises A443T in SEQ ID NO: 1 and optionally thehuman comprises such a PCSK9 or a nucleotide sequence encoding such aPCSK9 (eg, wherein the method is for treating or preventingdislipidemia, eg increasing cholesterol in the human).

In a Second Aspect:

The ligand of aspect 1, wherein the ligand has been or is determined ascapable of binding a human PCSK9 selected from the group consistingforms f c, r, p, m, e, h, aj and q.

In the alternative the ligand has been or is determined as capable ofbinding a human PCSK9 comprising a mutation R46L, A53V, N425S, A443T,I474V, Q619P and E670G (eg, comprises a mutation I474, E670G, N425S orQ619P) in SEQ ID NO: 1; for example, the PCSK9 comprises I474V in SEQ IDNO: 1 and optionally the human comprises such a PCSK9 or a nucleotidesequence encoding such a PCSK9 (eg, wherein the method is for treatingor preventing dislipidemia, eg reducing cholesterol or maintainingreduced cholesterol in the human); for example, the PCSK9 comprisesE670G in SEQ ID NO: 1 and optionally the human comprises such a PCSK9 ora nucleotide sequence encoding such a PCSK9 (eg, wherein the method isfor treating or preventing dislipidemia, eg reducing cholesterol ormaintaining reduced cholesterol in the human); for example, the PCSK9comprises Q619P in SEQ ID NO: 1 and optionally the human comprises sucha PCSK9 or a nucleotide sequence encoding such a PCSK9 (eg, wherein themethod is for treating or preventing dislipidemia, eg reducingcholesterol or maintaining reduced cholesterol in the human); forexample, the PCSK9 comprises N425S in SEQ ID NO: 1 and optionally thehuman comprises such a PCSK9 or a nucleotide sequence encoding such aPCSK9 (eg, wherein the method is for treating or preventingdislipidemia, eg reducing cholesterol or maintaining reduced cholesterolin the human); for example, the PCSK9 comprises R46L in SEQ ID NO: 1 andoptionally the human comprises such a PCSK9 or a nucleotide sequenceencoding such a PCSK9 (eg, wherein the method is for treating orpreventing dislipidemia, eg increasing cholesterol in the human); forexample, the PCSK9 comprises A53V in SEQ ID NO: 1 and optionally thehuman comprises such a PCSK9 or a nucleotide sequence encoding such aPCSK9 (eg, wherein the method is for treating or preventingdislipidemia, eg increasing cholesterol in the human); for example, thePCSK9 comprises A443T in SEQ ID NO: 1 and optionally the human comprisessuch a PCSK9 or a nucleotide sequence encoding such a PCSK9 (eg, whereinthe method is for treating or preventing dislipidemia, eg increasingcholesterol in the human).

In an example of any aspect, the ligand binds (or has been determined tobind) two, three, four or more human PCSK9 selected from the groupconsisting forms f c, r, p, m, e, h, aj and q or said PCSK9s in saidalternative.

In an example of any aspect, the ligand comprises a protein domain thatspecifically binds to PCSK9, eg, a human PCSK9 selected from the groupconsisting forms f c, r, p, m, e, h, aj and q, or said PCSK9s in saidalternative.

The term “specifically binds,” or the like, means that a ligand, eg, anantibody or antigen-binding fragment thereof, forms a complex with anantigen that is relatively stable under physiologic conditions. Specificbinding can be characterized by an equilibrium dissociation constant ofat least about 1×10⁻⁶M or less (e.g., a smaller KD denotes a tighterbinding). Methods for determining whether two molecules specificallybind are well known in the art and include, for example, equilibriumdialysis, surface plasmon resonance, and the like. An isolated antibodythat specifically binds a human PCSK9 may, however, exhibitcross-reactivity to other antigens such as a PCSK9 molecule from anotherspecies. Moreover, multi-specific antibodies (e.g., bispecifics) thatbind to human PCSK9 and one or more additional antigens are nonethelessconsidered antibodies that “specifically bind” PCSK9, as used herein.

In an example of any aspect, the ligand comprises or consists of aprotein that mimics the EGFA domain of the LDL receptor and specificallybinds to PCSK9, eg, a human PCSK9 selected from the group consistingforms f c, r, p, m, e, h, aj and q, or said PCSK9s in said alternative.

In an example of any aspect, the ligand antagonises PCSK9, eg, a humanPCSK9 selected from the group consisting forms f c, r, p, m, e, h, ajand q, or said PCSK9s in said alternative.

In an example of any aspect, the method comprises (before administeringthe ligand) the step of determining that the ligand is capable ofbinding a human PCSK9 selected from the group consisting forms f c, r,p, m, e, h, aj and q, or said PCSK9s in said alternative.

In an example of any aspect, binding is determined by SPR. In an exampleof any aspect, binding is determined by ELISA.

In an example of any aspect, said forms are the mature forms.

In an example of any aspect, said forms are the pro-forms.

In a Third Aspect:

A ligand that binds (i) a PCSK9 of said alternative or (ii) a humanPCSK9 comprising an amino acid sequence selected from the groupconsisting of SEQ ID NOs: 4-27 for use in a method comprising the stepof using the ligand to target said PCSK9 in a human to treat and/orprevent a disease or condition mediated by PCSK9, the method comprisingadministering the ligand to the human.

In an example, the disease or condition is mediated by (i) a PCSK9 ofsaid alternative or (ii) a human PCSK9 comprising an amino acid sequenceselected from the group consisting of SEQ ID NOs: 4-27.

In an example, the amino acid sequence selected from the groupconsisting of SEQ ID NOs: 4-23, 26 and 27; or selected from the groupconsisting of SEQ ID NOs: 4-14 and 18-27; or selected from the groupconsisting of SEQ ID NOs: 4-14, 18-23, 26 and 27. These arenaturally-occurring sequences that do not comprise 46L and which meetthe criteria set out above. These groups comprise variants that areassociated with elevated LDL-C.

In an example, the amino acid sequence is SEQ ID NO: 18, 19 or 20, thatcomprises a 425S, which is associated with elevated LDL-C (Pisciotta etal 2006).

In an example, the amino acid sequence selected from the groupconsisting of SEQ ID NOs: 10, 11, 12, 26 and 27, that comprise 670Gwhich is a marker for severity of coronary atherosclerosis (Chen et al2005).

In an example, the amino acid sequence selected from the groupconsisting of SEQ ID NOs: 10-14 and 18-27; or selected from the groupconsisting of SEQ ID NOs: 10-14, 18-23, 26 and 27. These are sequencesthat have a naturally-occurring combination of differences from SEQ IDNOs: 1-3 (form a) and which meet the criteria set out above.

In an example, the amino acid sequence is SEQ ID NO: 4.

In an example, the amino acid sequence is SEQ ID NO: 5.

In an example, the amino acid sequence is SEQ ID NO: 6.

In an example, the amino acid sequence is SEQ ID NO: 7.

In an example, the amino acid sequence is SEQ ID NO: 8.

In an example, the amino acid sequence is SEQ ID NO: 9.

In an example, the amino acid sequence is SEQ ID NO: 10.

In an example, the amino acid sequence is SEQ ID NO: 11.

In an example, the amino acid sequence is SEQ ID NO: 12.

In an example, the amino acid sequence is SEQ ID NO: 13.

In an example, the amino acid sequence is SEQ ID NO: 14.

In an example, the amino acid sequence is SEQ ID NO: 15.

In an example, the amino acid sequence is SEQ ID NO: 16.

In an example, the amino acid sequence is SEQ ID NO: 17.

In an example, the amino acid sequence is SEQ ID NO: 18.

In an example, the amino acid sequence is SEQ ID NO: 19.

In an example, the amino acid sequence is SEQ ID NO: 20.

In an example, the amino acid sequence is SEQ ID NO: 21.

In an example, the amino acid sequence is SEQ ID NO: 22.

In an example, the amino acid sequence is SEQ ID NO: 23.

In an example, the amino acid sequence is SEQ ID NO: 24.

In an example, the amino acid sequence is SEQ ID NO: 25.

In an example, the amino acid sequence is SEQ ID NO: 26.

In an example, the amino acid sequence is SEQ ID NO: 27.

In a Fourth Aspect:

The ligand of aspect 3, wherein the genome of the human comprises anucleotide sequence selected from the group consisting of SEQ ID NOs:29-37; or a nucleotide sequence encoding a PCSK9 of said alternative.

In an example, the nucleotide sequence is selected from the groupconsisting of SEQ ID NOs: 29-35 and 37; or selected from the groupconsisting of SEQ ID NOs: 29-32 and 34-37; or selected from the groupconsisting of SEQ ID NOs: 29-32, 34, 35 and 37. These arenaturally-occurring allele (haplotype) sequences that do not encode 46Land which meet the criteria set out above. These groups comprisevariants that are associated with elevated LDL-C.

In an example, the nucleotide sequence is SEQ ID NO: 34, that encodes a425S, which is associated with elevated LDL-C (Pisciotta et al 2006).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31 and 37, that encode 670G which is a markerfor severity of coronary atherosclerosis (Chen et al 2005).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31, 32, 34, 35, 36 and 37; or selected fromthe group consisting of SEQ ID NOs: 31, 32, 34, 35 and 37. These areallele (haplotype) sequences that have a naturally-occurring combinationof differences from SEQ ID NO: 28 (form a) and which meet the criteriaset out above.

In an example, the nucleotide sequence is SEQ ID NO: 29

In an example, the nucleotide sequence is SEQ ID NO: 30.

In an example, the nucleotide sequence is SEQ ID NO: 31.

In an example, the nucleotide sequence is SEQ ID NO: 32.

In an example, the nucleotide sequence is SEQ ID NO: 33

In an example, the nucleotide sequence is SEQ ID NO: 34

In an example, the nucleotide sequence is SEQ ID NO: 35.

In an example, the nucleotide sequence is SEQ ID NO: 36.

In an example, the nucleotide sequence is SEQ ID NO: 37.

In a Fifth Aspect:

The ligand of any preceding aspect, wherein the human has been or isgenotyped as positive for a nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 29-37 or at least the catalytic domain- orC-terminal domain-encoding sequence thereof.

In an example, the nucleotide sequence is selected from the groupconsisting of SEQ ID NOs: 29-35 and 37; or selected from the groupconsisting of SEQ ID NOs: 29-32 and 34-37; or selected from the groupconsisting of SEQ ID NOs: 29-32, 34, 35 and 37. These arenaturally-occurring allele (haplotype) sequences that do not encode 46Land which meet the criteria set out above. These groups comprisevariants that are associated with elevated LDL-C.

In an example, the nucleotide sequence is SEQ ID NO: 34, that encodes a425S, which is associated with elevated LDL-C (Pisciotta et al 2006).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31 and 37, that encode 670G which is a markerfor severity of coronary atherosclerosis (Chen et al 2005).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31, 32, 34, 35, 36 and 37; or selected fromthe group consisting of SEQ ID NOs: 31, 32, 34, 35 and 37. These areallele (haplotype) sequences that have a naturally-occurring combinationof differences from SEQ ID NO: 28 (form a) and which meet the criteriaset out above.

In an example, the nucleotide sequence is SEQ ID NO: 29.

In an example, the nucleotide sequence is SEQ ID NO: 30.

In an example, the nucleotide sequence is SEQ ID NO: 31.

In an example, the nucleotide sequence is SEQ ID NO: 32.

In an example, the nucleotide sequence is SEQ ID NO: 33.

In an example, the nucleotide sequence is SEQ ID NO: 34.

In an example, the nucleotide sequence is SEQ ID NO: 35.

In an example, the nucleotide sequence is SEQ ID NO: 36.

In an example, the nucleotide sequence is SEQ ID NO: 37.

In a Sixth Aspect:

The ligand of any preceding aspect, wherein the human has been or isphenotyped as positive for (i) a PCSK9 of said alternative or (ii) ahuman PCSK9 selected from the group consisting of forms f c, r, p, m, e,h, aj and q or at least the catalytic or C-terminal domain thereof.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In a Seventh Aspect:

The ligand of any preceding aspect, wherein the method comprisesgenotyping the human as positive for a nucleotide sequence selected fromthe group consisting of SEQ ID NOs: 29-37 or at least the catalyticdomain- or C-terminal domain-encoding sequence thereof; or a nucleotidesequence encoding a PCSK9 of said alternative.

In an example, the nucleotide sequence is selected from the groupconsisting of SEQ ID NOs: 29-35 and 37; or selected from the groupconsisting of SEQ ID NOs: 29-32 and 34-37; or selected from the groupconsisting of SEQ ID NOs: 29-32, 34, 35 and 37. These arenaturally-occurring allele (haplotype) sequences that do not encode 46Land which meet the criteria set out above. These groups comprisevariants that are associated with elevated LDL-C.

In an example, the nucleotide sequence is SEQ ID NO: 34, that encodes a425S, which is associated with elevated LDL-C (Pisciotta et al 2006).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31 and 37, that encode 670G which is a markerfor severity of coronary atherosclerosis (Chen et al 2005).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31, 32, 34, 35, 36 and 37; or selected fromthe group consisting of SEQ ID NOs: 31, 32, 34, 35 and 37. These areallele (haplotype) sequences that have a naturally-occurring combinationof differences from SEQ ID NO: 28 (form a) and which meet the criteriaset out above.

In an example, the nucleotide sequence is SEQ ID NO: 29.

In an example, the nucleotide sequence is SEQ ID NO: 30.

In an example, the nucleotide sequence is SEQ ID NO: 31.

In an example, the nucleotide sequence is SEQ ID NO: 32.

In an example, the nucleotide sequence is SEQ ID NO: 33.

In an example, the nucleotide sequence is SEQ ID NO: 34.

In an example, the nucleotide sequence is SEQ ID NO: 35.

In an example, the nucleotide sequence is SEQ ID NO: 36.

In an example, the nucleotide sequence is SEQ ID NO: 37.

In an Eighth Aspect:

The ligand of any preceding aspect, wherein the method comprisesphenotyping the human has positive for (i) a PCSK9 of said alternativeor (ii) a human PCSK9 selected from the group consisting of forms f c,r, p, m, e, h, aj and q or at least the catalytic or C-terminal domainthereof.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In a Ninth Aspect:

The ligand of any preceding aspect, wherein the human has been or isgenotyped as heterozygous for a nucleotide sequence selected from thegroup consisting of SEQ ID NOs: 29-37 or at least the catalytic domain-or C-terminal domain-encoding sequence thereof; or a nucleotide sequenceencoding a PCSK9 of said alternative; optionally wherein the human hasbeen or is genotyped as comprising the nucleotide sequence of SEQ ID NO:28 or at least the catalytic domain- or C-terminal domain-encodingsequence thereof and a nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 29-37 or at least the catalytic domain- orC-terminal domain-encoding sequence thereof; or a nucleotide sequenceencoding a PCSK9 of said alternative.

“Heterozygous” here means that in the human's genotype one allelecomprises a nucleotide sequence selected from the group consisting ofSEQ ID NOs: 29-37 or at least the catalytic domain- or C-terminaldomain-encoding sequence thereof and other allele can be any PCSK9 (eg,form a, a′ or an allele comprising a nucleotide sequence selected fromthe group consisting of SEQ ID NOs: 29-37 or at least the catalyticdomain- or C-terminal domain-encoding sequence thereof).

In an example, the method comprises (before administering the ligand)genotyping the human as heterozygous for a nucleotide sequence selectedfrom the group consisting of SEQ ID NOs: 29-37 or at least the catalyticdomain- or C-terminal domain-encoding sequence thereof; optionally alsogenotyping the human as comprising the nucleotide sequence of SEQ ID NO:28 or at least the catalytic domain- or C-terminal domain-encodingsequence thereof and a nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 29-37 or at least the catalytic domain- orC-terminal domain-encoding sequence thereof.

In an example, the nucleotide sequence is selected from the groupconsisting of SEQ ID NOs: 29-35 and 37; or selected from the groupconsisting of SEQ ID NOs: 29-32 and 34-37; or selected from the groupconsisting of SEQ ID NOs: 29-32, 34, 35 and 37.

These are naturally-occurring allele (haplotype) sequences that do notencode 46L and which meet the criteria set out above. These groupscomprise variants that are associated with elevated LDL-C.

In an example, the nucleotide sequence is SEQ ID NO: 34, that encodes a425S, which is associated with elevated LDL-C (Pisciotta et al 2006).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31 and 37, that encode 670G which is a markerfor severity of coronary atherosclerosis (Chen et al 2005).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31, 32, 34, 35, 36 and 37; or selected fromthe group consisting of SEQ ID NOs: 31, 32, 34, 35 and 37. These areallele (haplotype) sequences that have a naturally-occurring combinationof differences from SEQ ID NO: 28 (form a) and which meet the criteriaset out above.

In an example, the nucleotide sequence is SEQ ID NO: 29.

In an example, the nucleotide sequence is SEQ ID NO: 30.

In an example, the nucleotide sequence is SEQ ID NO: 31.

In an example, the nucleotide sequence is SEQ ID NO: 32.

In an example, the nucleotide sequence is SEQ ID NO: 33.

In an example, the nucleotide sequence is SEQ ID NO: 34.

In an example, the nucleotide sequence is SEQ ID NO: 35.

In an example, the nucleotide sequence is SEQ ID NO: 36.

In an example, the nucleotide sequence is SEQ ID NO: 37.

In a Tenth Aspect:

The ligand of any one of aspects 1 to 9, wherein the genome of the humanhas been or is genotyped as homozygous for a nucleotide sequenceselected from the group consisting of SEQ ID NOs: 29-37 or at least thecatalytic domain- or C-terminal domain-encoding sequence thereof; or anucleotide sequence encoding a PCSK9 of said alternative.

“Homozygous” here means that in the human's genotype each allelecomprises the same nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 29-37 or at least the catalytic domain- orC-terminal domain-encoding sequence thereof.

In an example, the method comprises genotyping the human as homozygousfor a nucleotide sequence selected from the group consisting of SEQ IDNOs: 29-37 or at least the catalytic domain- or C-terminaldomain-encoding sequence thereof; or a nucleotide sequence encoding aPCSK9 of said alternative.

In an example, the nucleotide sequence is selected from the groupconsisting of SEQ ID NOs: 29-35 and 37; or selected from the groupconsisting of SEQ ID NOs: 29-32 and 34-37; or selected from the groupconsisting of SEQ ID NOs: 29-32, 34, 35 and 37. These arenaturally-occurring allele (haplotype) sequences that do not encode 46Land which meet the criteria set out above. These groups comprisevariants that are associated with elevated LDL-C.

In an example, the nucleotide sequence is SEQ ID NO: 34, that encodes a425S, which is associated with elevated LDL-C (Pisciotta et al 2006).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31 and 37, that encode 670G which is a markerfor severity of coronary atherosclerosis (Chen et al 2005).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31, 32, 34, 35, 36 and 37; or selected fromthe group consisting of SEQ ID NOs: 31, 32, 34, 35 and 37. These areallele (haplotype) sequences that have a naturally-occurring combinationof differences from SEQ ID NO: 28 (form a) and which meet the criteriaset out above.

In an example, the nucleotide sequence is SEQ ID NO: 29.

In an example, the nucleotide sequence is SEQ ID NO: 30.

In an example, the nucleotide sequence is SEQ ID NO: 31.

In an example, the nucleotide sequence is SEQ ID NO: 32.

In an example, the nucleotide sequence is SEQ ID NO: 33.

In an example, the nucleotide sequence is SEQ ID NO: 34.

In an example, the nucleotide sequence is SEQ ID NO: 35.

In an example, the nucleotide sequence is SEQ ID NO: 36.

In an example, the nucleotide sequence is SEQ ID NO: 37.

In an Eleventh Aspect:

The ligand of any preceding aspect, wherein the ligand comprises anantibody binding site that binds (i) a PCSK9 of said alternative or (ii)a human PCSK9 comprising an amino acid sequence selected from the groupconsisting of SEQ ID NOs: 4-27 and optionally has been or is determinedas capable of such binding.

In an example, the method comprises (before administering the ligand)the step of determining that the ligand is capable of binding to saidhuman PCSK9.

In an example, the binding is specific binding. In an example, theligand binds (or has been determined as binding) to the PCSK9 with anaffinity (Kd) of 1 mM, 100 nM, 10 nM or 1 nM or less. In an embodiment,the affinity is no less than 10, 100 or 1000 fM.

In an example, binding or affinity is determined by SPR or ELISA.

In an example, the disease or condition is mediated by a human PCSK9comprising an amino acid sequence selected from the group consisting ofSEQ ID NOs: 4-27.

In an example, the amino acid sequence selected from the groupconsisting of SEQ ID NOs: 4-23, 26 and 27; or selected from the groupconsisting of SEQ ID NOs: 4-14 and 18-27; or selected from the groupconsisting of SEQ ID NOs: 4-14, 18-23, 26 and 27. These arenaturally-occurring sequences that do not comprise 46L and which meetthe criteria set out above. These groups comprise variants that areassociated with elevated LDL-C.

In an example, the amino acid sequence is SEQ ID NO: 18, 19 or 20, thatcomprises a 425S, which is associated with elevated LDL-C (Pisciotta etal 2006).

In an example, the amino acid sequence selected from the groupconsisting of SEQ ID NOs: 10, 11, 12, 26 and 27, that comprise 670Gwhich is a marker for severity of coronary atherosclerosis (Chen et al2005).

In an example, the amino acid sequence selected from the groupconsisting of SEQ ID NOs: 10-14 and 18-27; or selected from the groupconsisting of SEQ ID NOs: 10-14, 18-23, 26 and 27. These are sequencesthat have a naturally-occurring combination of differences from SEQ IDNOs: 1-3 (form a) and which meet the criteria set out above

In an example, the amino acid sequence is SEQ ID NO: 4.

In an example, the amino acid sequence is SEQ ID NO: 5.

In an example, the amino acid sequence is SEQ ID NO: 6.

In an example, the amino acid sequence is SEQ ID NO: 7.

In an example, the amino acid sequence is SEQ ID NO: 8.

In an example, the amino acid sequence is SEQ ID NO: 9.

In an example, the amino acid sequence is SEQ ID NO: 10.

In an example, the amino acid sequence is SEQ ID NO: 11.

In an example, the amino acid sequence is SEQ ID NO: 12.

In an example, the amino acid sequence is SEQ ID NO: 13.

In an example, the amino acid sequence is SEQ ID NO: 14.

In an example, the amino acid sequence is SEQ ID NO: 15.

In an example, the amino acid sequence is SEQ ID NO: 16.

In an example, the amino acid sequence is SEQ ID NO: 17.

In an example, the amino acid sequence is SEQ ID NO: 18.

In an example, the amino acid sequence is SEQ ID NO: 19.

In an example, the amino acid sequence is SEQ ID NO: 20.

In an example, the amino acid sequence is SEQ ID NO: 21.

In an example, the amino acid sequence is SEQ ID NO: 22.

In an example, the amino acid sequence is SEQ ID NO: 23.

In an example, the amino acid sequence is SEQ ID NO: 24.

In an example, the amino acid sequence is SEQ ID NO: 25.

In an example, the amino acid sequence is SEQ ID NO: 26.

In an example, the amino acid sequence is SEQ ID NO: 27.

In a Twelfth Aspect:

The ligand of aspect 11, wherein the ligand is an antibody or antibodyfragment. For example, the antibody or antibody fragment is a PCSK9antagonist, eg, neutralises PCSK9.

Examples of such antibodies are disclosed, for instance, in WO2008/057457, WO2008/057458, WO 2008/057459, WO 2008/063382, WO2008/133647, WO 2009/100297, WO 2009/100318, WO 2011/037791, WO2011/053759, WO 2011/053783, WO 2008/125623, WO 2011/072263, WO2009/055783, WO 2010/029513, WO 2011/111007, WO 2010/077854, thedisclosures and sequences of such antibodies being incorporated hereinfor use in the invention in their entireties by reference. One specificexample is AMG 145 (Amgen), LY3015014 (Eli Lilly) or alirocumab.Advantageously, the ligand is or comprises alirocumab. Alternatively,the ligand is or comprises evolocumab.

In an example, the ligand is SAR236553/REGN727 (SanofiAventis/Regeneron) or a PCSK9-binding derivative thereof.

In an example, the ligand comprises or consists of a neutralizingantibody that binds to the PCSK9, wherein the antibody binds to PCSK9and reduces the likelihood that PCSK9 binds to LDLR.

The ligand of aspect 11, wherein the ligand is a PCSK9 antagonist, eg,neutralises PCSK9.

In an example of any aspect of the invention, the ligand comprises orconsists a ligand selected from evolocumab, 1D05-IgG2 (Merck & Co.),ALN-PCS02 (Alnylam), RN316 (Pfizer-Rinat), LY3015014 (Eli Lilly) andalirocumab (SAR236553/REGN727; Sanofi Aventis/Regeneron).

In Thirteenth Aspect:

The ligand of any one of aspects 1 to 10, wherein (i) the ligandcomprises a sequence of contiguous nucleotides that specificallyhybridises to a nucleotide sequence selected from the group consistingof SEQ ID NOs: 29-37 or at least the catalytic domain- or C-terminaldomain-encoding sequence thereof (or hybridizes to a nucleotide sequenceencoding a PCSK9 of said alternative), or specifically hybridises to anantisense sequence or an RNA transcript of said sequence, wherein saidsequence of contiguous nucleotides hybridises to at least one nucleotidepresent in said selected sequence which is not present in SEQ ID NO: 28or hybridises to an antisense sequence or an RNA transcript thereofrespectively; and/or (ii) the ligand comprises a sequence of at least 10contiguous nucleotides of a nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 29-37 thereof (or a nucleotide sequenceencoding a PCSK9 of said alternative) or is an antisense sequence or RNAversion of said contiguous nucleotides, wherein said sequence ofcontiguous nucleotides comprises at least one nucleotide present in saidselected sequence which is not present in SEQ ID NO: 28.

In an example, the nucleotide sequence is selected from the groupconsisting of SEQ ID NOs: 29-35 and 37; or selected from the groupconsisting of SEQ ID NOs: 29-32 and 34-37; or selected from the groupconsisting of SEQ ID NOs: 29-32, 34, 35 and 37. These arenaturally-occurring allele (haplotype) sequences that do not encode 46Land which meet the criteria set out above. These groups comprisevariants that are associated with elevated LDL-C.

In an example, the nucleotide sequence is SEQ ID NO: 34, that encodes a425S, which is associated with elevated LDL-C (Pisciotta et al 2006).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31 and 37, that encode 670G which is a markerfor severity of coronary atherosclerosis (Chen et al 2005).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31, 32, 34, 35, 36 and 37; or selected fromthe group consisting of SEQ ID NOs: 31, 32, 34, 35 and 37. These areallele (haplotype) sequences that have a naturally-occurring combinationof differences from SEQ ID NO: 28 (form a) and which meet the criteriaset out above.

In an example, the nucleotide sequence is SEQ ID NO: 29.

In an example, the nucleotide sequence is SEQ ID NO: 30.

In an example, the nucleotide sequence is SEQ ID NO: 31.

In an example, the nucleotide sequence is SEQ ID NO: 32.

In an example, the nucleotide sequence is SEQ ID NO: 33.

In an example, the nucleotide sequence is SEQ ID NO: 34.

In an example, the nucleotide sequence is SEQ ID NO: 35.

In an example, the nucleotide sequence is SEQ ID NO: 36.

In an example, the nucleotide sequence is SEQ ID NO: 37.

In an embodiment, the ligand comprises at least 10, 11, 12, 13, 14, 15,20, 25, 30, 35, 40, 45, 50 or 100 contiguous nucleotides of saidnucleotide sequence.

In a Fourteenth Aspect:

The ligand of any preceding aspect, wherein said disease or condition ishyperlipidaemia, hypercholesterolaemia (eg, familialhypercholesterolaemia), heart attack, stroke, coronary heart disease,atherosclerosis or a cardiovascular disease or condition.

The ligand of any preceding aspect, wherein the disease or condition ishypercholesterolemia, hyperlipidemia, hypercholesterolemia,dyslipidemia, cholestatic liver disease, nephrotic syndrome,hypothyroidism, obesity, atherosclerosis or a cardiovascular disease.

In an example, said disease or condition is hypercholesterolaemia. Theterm “hypercholesterolaemia,” as used herein, refers to a condition inwhich cholesterol levels are elevated above a desired level. In someembodiments, this denotes that serum cholesterol levels are elevated. Insome embodiments, the desired level takes into account various “riskfactors” that are known to one of skill in the art (and are described orreferenced in US20120093818).

The ligand of any preceding aspect, wherein the human is identified asheterozygous for Familial Hypercholesterolemia, statin intolerant,statin uncontrolled, or at risk for developing hypercholesterolemia,dyslipidemia, cholestatic liver disease, nephrotic syndrome,hypothyroidism, obesity, atherosclerosis or a cardiovascular disease.

In a Fifteenth Aspect:

The ligand of any preceding aspect, wherein said disease or condition isassociated with elevated LDL cholesterol.

Cholesterol levels are measured in milligrams (mg) of cholesterol perdeciliter (dL) of blood in the United States and some other countries.Canada and most European countries measure cholesterol in millimoles(mmol) per liter (L) of blood. Below are general guideline ideal rangesand elevated ranges.

Total cholesterol Total cholesterol* (U.S. and some other countries)(Canada and most of Europe) Below 200 mg/dL Below 5.2 mmol/L Ideal200-239 mg/dL 5.2-6.2 mmol/L Borderline high 240 mg/dL and above Above6.2 mmol/L High LDL cholesterol LDL cholesterol* (U.S. and some othercountries) (Canada and most of Europe) 100-129 mg/dL 2.6-3.3 mmol/LIdeal 130-159 mg/dL 3.4-4.1 mmol/L Borderline high 160-189 mg/dL 4.1-4.9mmol/L High 190 mg/dL and above Above 4.9 mmol/L Very high *Canadian andEuropean guidelines differ slightly from U.S. guidelines. Theseconversions are based on U.S. guidelines.

Elevated LDL cholesterol is, therefore, 160 mg/dL or above (4.1 mmol/Lor above).

In a Sixteenth Aspect:

The ligand of any preceding aspect, wherein the ligand inhibits humanPCSK9 binding to human LDL receptor and optionally has been or isdetermined as capable of such inhibition.

In an example, the method comprises (before administering the ligand)determining that the ligand is capable of such inhibition.

Inhibition determination is eg, inhibition in a blood or serum sample,at rtp, at ph7, at 37 degrees centigrade and/or under the physiologicalconditions of a human body.

In a Seventeeth Aspect:

The ligand of any preceding aspect, wherein the human is resistant orsubstantially resistant to statin (eg, avorstatin and/or fluvastatin)treatment of said disease or condition.

In an Eighteenth Aspect:

The ligand of any preceding aspect, wherein the ligand is for treatingand/or preventing a PCSK9-mediated disease or condition in a human

(i) whose genome comprises SEQ ID NO: 29 and wherein the human is ofASW,YRI,GBR,TSI, CLM,LWK,MXL,JPT,PUR,IBS,FIN or CEU ancestry; or

(ii) whose genome comprises SEQ ID NO: 30 and wherein the human is ofASW,YRI,GBR,TSI,CLM, CHB,LWK,CHS,JPT,PUR,FIN or CEU ancestry; or

(iii) whose genome comprises SEQ ID NO: 32 and wherein the human is ofASW,GBR,TSI,CLM, JPT,PUR,IBS,FIN or CEU ancestry; or

(iv) whose genome comprises SEQ ID NO: 33 and wherein the human is ofLWK,ASW,YRI or CLM ancestry; or

(v) whose genome comprises SEQ ID NO: 34 and wherein the human is ofLWK,ASW or YRI ancestry; or

(vi) whose genome comprises SEQ ID NO: 35 and wherein the human is ofPUR,TSI,FIN or CEU ancestry; or

(vii) whose genome comprises SEQ ID NO: 36 and wherein the human is ofLWK,ASW or YRI ancestry; or

(viii) whose genome comprises SEQ ID NO: 37 and wherein the human is ofCHS,ASW,JPT,PUR or CHB ancestry.

In a Ninteenth Aspect:

The ligand of any preceding aspect, wherein the ligand is for treatingand/or preventing a PCSK9-mediated disease or condition in a human

(i) that expresses PCSK9 form f and wherein the human is ofASW,YRI,GBR,TSI,CLM,LWK,MXL,JPT,PUR,IBS,FIN or CEU ancestry; or

(ii) that expresses PCSK9 form c and wherein the human is ofASW,YRI,GBR,TSI,CLM,CHB,LWK,CHSJPT,PUR,FIN or CEU ancestry; or

(iii) that expresses PCSK9 form p and wherein the human is ofASW,GBR,TSI,CLMJPT,PUR,IBS,FIN or CEU ancestry; or

(iv) that expresses PCSK9 form m and wherein the human is of LWK,ASW,YRIor CLM ancestry; or

(v) that expresses PCSK9 form e and wherein the human is of LWK,ASW orYRI ancestry; or

(vi) that expresses PCSK9 form h and wherein the human is of PUR,TSI,FINor CEU ancestry; or

(vii) that expresses PCSK9 form aj and wherein the human is of LWK,ASWor YRI ancestry; or

(viii) that expresses PCSK9 form q and wherein the human is ofCHS,ASW,JPT,PUR or CHB ancestry.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In a Twentieth Aspect:

A pharmaceutical composition or kit for treating and/or preventing aPCSK9-mediated condition or disease (eg, as recited in aspect 14 or 15),the composition or kit comprising a ligand of any preceding aspect andoptionally a statin (eg, cerovastatin, atorvastatin, simvastatin,pitavastin, rosuvastatin, fluvastatin, lovastatin or pravastatin); andoptionally in combination with a label or instructions for use to treatand/or prevent said disease or condition in a human (eg, coveringtreatment of a human as recited in aspect 18 or 19); optionally whereinthe label or instructions comprise a marketing authorisation number (eg,an FDA or EMA authorisation number); optionally wherein the label orinstructions comprise directions to administer alirocumab or evolocumabto said human; optionally wherein the kit comprises an IV or injectiondevice that comprises the ligand (and, eg, also a statin).

In a Twenty-First Aspect:

A method of producing an anti-human PCSK9 antibody binding site, themethod comprising obtaining a plurality of anti-PCSK9 antibody bindingsites, screening the antibody binding sites for binding to (i) a PCSK9of said alternative or (ii) a human PCSK9 selected from the groupconsisting of forms f c, r, p, m, e, h, aj and q or a catalytic orC-terminal domain or a peptide thereof that comprises amino acidvariation from the corresponding sequence of SEQ ID NO: 1, 2 or 3 andisolating an antibody binding site that binds in the screening step, andoptionally producing a form f c, r, p, m, e, h, aj or q PCSK9-bindingfragment or derivative of the isolated antibody.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In an example of this and the next aspect, the plurality of bindingsites comprises or consists of a plurality of 4-chain antibodies orfragments thereof, eg, dAbs, Fabs or scFvs. Suitable methods forproducing pluralities of binding sites for screening include phagedisplay (producing a phage display library of antibody binding sites),ribosome display (producing a ribosome display library of antibodybinding sites), yeast display (producing a yeast display library ofantibody binding sites), or immunisation of a non-human vertebrate (eg,a rodent, eg, a mouse or rat, eg, a Velocimouse™, Kymouse™, Xenomouse™,Aliva Mouse™, HuMab Mouse™, Omnimouse™ Omnirat™ or MeMo Mouse™) with aPCSK9 epitope and isolation of a repertoire of antibody-producing cells(eg, a B-cell, plasma cell or plasmablast repertoire) and/or arepertoire of isolated antibodies.

In an example, the method comprises selecting one or more antibodybinding sites that each specifically binds to a human PCSK9 epitopecomprising amino acid variation from the corresponding sequence of SEQID NO: 1, 2 or 3.

In a Twenty-Second Aspect:

A method of producing an anti-human PCSK9 antibody, the methodcomprising immunising a non-human vertebrate (eg, a mouse or a rat) with(i) a PCSK9 of said alternative or (ii) a human PCSK9 comprising anamino acid sequence selected from the group consisting of the amino acidsequences of forms f c, r, p, m, e, h, aj and q or a catalytic orC-terminal domain or a peptide thereof that comprises amino acidvariation from the corresponding sequence of SEQ ID NO: 1, 2 or 3 andisolating an antibody that binds a human PCSK9 comprising selected fromthe group consisting of forms f c, r, p, m, e, h, aj and q or acatalytic or C-terminal domain or a peptide thereof that comprises aminoacid variation from the corresponding sequence of SEQ ID NO: 1, 2 or 3,and optionally producing a form f c, r p, m, e, h, aj or q PCSK9-bindingfragment or derivative of the isolated antibody.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In a Twenty-Third Aspect:

The method of aspect 21 or 22, comprising the step of obtaining anucleic acid encoding the antibody, fragment, derivative or binding siteand optionally inserting the nucleic acid in an expression vector.

For example, the method comprises isolating a cell (eg, B-cell,plasmablast, plasma cell or memory cell) comprising the nucleic acid,wherein the cell is obtained from a non-human vertebrate that has beenimmunised with the PCSK9 epitope.

In a Twenty-Fourth Aspect:

A kit for PCSK9 genotyping a human, wherein the kit comprises a nucleicacid (i) comprising a sequence of 10 or more (eg, 10, 15, 20, 30, 40,50, 60, 70, 80, 90, 100 or more) contiguous nucleotides thatspecifically hybridises to (i) a nucleotide sequence encoding a PCSK9 ofsaid alternative or (ii) a nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 29-37 or at least the catalytic domain- orC-terminal domain-encoding sequence thereof, or specifically hybridisesto an antisense sequence or an RNA transcript of said sequence, whereinsaid sequence of contiguous nucleotides hybridises to at least onenucleotide present in said selected sequence which is not present in SEQID NO: 28 or hybridises to an antisense sequence or an RNA transcriptthereof; and/or (ii) comprising a sequence of at least 10 or more (eg,10, 15, 20, 30, 40, 50, 60, 70, 80, 90, 100 or more) nucleotides of anucleotide sequence selected from the group consisting of SEQ ID NOs:29-37 (or the nucleotide sequence of (i)) or comprising an antisensesequence or RNA version of said contiguous nucleotides, wherein saidsequence of contiguous nucleotides comprises at least one nucleotidepresent in said selected sequence which is not present in SEQ ID NO: 28.

In an example, the nucleotide sequence is selected from the groupconsisting of SEQ ID NOs: 29-35 and 37; or selected from the groupconsisting of SEQ ID NOs: 29-32 and 34-37; or selected from the groupconsisting of SEQ ID NOs: 29-32, 34, 35 and 37. These arenaturally-occurring allele (haplotype) sequences that do not encode 46Land which meet the criteria set out above. These groups comprisevariants that are associated with elevated LDL-C.

In an example, the nucleotide sequence is SEQ ID NO: 34, that encodes a425S, which is associated with elevated LDL-C (Pisciotta et al 2006).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31 and 37, that encode 670G which is a markerfor severity of coronary atherosclerosis (Chen et al 2005).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31, 32, 34, 35, 36 and 37; or selected fromthe group consisting of SEQ ID NOs: 31, 32, 34, 35 and 37. These areallele (haplotype) sequences that have a naturally-occurring combinationof differences from SEQ ID NO: 28 (form a) and which meet the criteriaset out above.

In an example, the nucleotide sequence is SEQ ID NO: 29.

In an example, the nucleotide sequence is SEQ ID NO: 30.

In an example, the nucleotide sequence is SEQ ID NO: 31.

In an example, the nucleotide sequence is SEQ ID NO: 32.

In an example, the nucleotide sequence is SEQ ID NO: 33.

In an example, the nucleotide sequence is SEQ ID NO: 34.

In an example, the nucleotide sequence is SEQ ID NO: 35.

In an example, the nucleotide sequence is SEQ ID NO: 36.

In an example, the nucleotide sequence is SEQ ID NO: 37.

In a Twenty-Fifth Aspect:

A kit for PCSK9 genotyping or phenotyping a human, wherein the kitcomprises a ligand according to any one of aspects 1 to 19 or anantibody, fragment or derivative produced by the method of any one ofaspects 21 to 23.

In a Twenty-Sixth Aspect:

Use of an anti-PCSK9 ligand that binds (i) a PCSK9 of said alternativeor (ii) a human PCSK9 selected from the group consisting of forms f c,r, p, m, e, h, aj and q in the manufacture of a medicament for treatingand/or preventing a PCSK9-mediated disease or condition in a human whosegenome comprises (iii) a nucleotide sequence encoding said PCSK9 of (i);or (iv) a nucleotide sequence selected from the group consisting of SEQID NOs: 29-37, optionally for treating and/or preventing aPCSK9-mediated disease or condition in a human as recited in aspect 18or 19.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In a Twenty-Seventh Aspect:

Use of an anti-PCSK9 ligand that binds (i) a PCSK9 of said alternativeor (ii) a human PCSK9 selected from the group consisting of forms f c,r, p, m, e, h, aj and q in the manufacture of a medicament for targetingsaid PCSK9 in a human to treat and/or prevent a disease or conditionmediated by PCSK9, optionally for targeting PCSK9 in a human as recitedin aspect 18 or 19.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In an example, the nucleotide sequence is selected from the groupconsisting of SEQ ID NOs: 29-35 and 37; or selected from the groupconsisting of SEQ ID NOs: 29-32 and 34-37; or selected from the groupconsisting of SEQ ID NOs: 29-32, 34, 35 and 37. These arenaturally-occurring allele (haplotype) sequences that do not encode 46Land which meet the criteria set out above. These groups comprisevariants that are associated with elevated LDL-C.

In an example, the nucleotide sequence is SEQ ID NO: 34, that encodes a425S, which is associated with elevated LDL-C (Pisciotta et al 2006).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31 and 37, that encode 670G which is a markerfor severity of coronary atherosclerosis (Chen et al 2005).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31, 32, 34, 35, 36 and 37; or selected fromthe group consisting of SEQ ID NOs: 31, 32, 34, 35 and 37. These areallele (haplotype) sequences that have a naturally-occurring combinationof differences from SEQ ID NO: 28 (form a) and which meet the criteriaset out above.

In an example, the nucleotide sequence is SEQ ID NO: 29.

In an example, the nucleotide sequence is SEQ ID NO: 30.

In an example, the nucleotide sequence is SEQ ID NO: 31.

In an example, the nucleotide sequence is SEQ ID NO: 32.

In an example, the nucleotide sequence is SEQ ID NO: 33.

In an example, the nucleotide sequence is SEQ ID NO: 34.

In an example, the nucleotide sequence is SEQ ID NO: 35.

In an example, the nucleotide sequence is SEQ ID NO: 36.

In an example, the nucleotide sequence is SEQ ID NO: 37.

The ligand can be any anti-PCSK9 ligand disclosed herein.

In a Twenty-Eight Aspect:

The use of aspect 26 or 27, wherein the ligand, human, disease orcondition is according to any one of aspects 1 to 19.

In a Twenty-Ninth Aspect:

A method of targeting a PCSK9 for treating and/or preventing aPCSK9-mediated disease or condition in a human, the method comprisingadministering an anti-PCSK9 ligand to a human comprising (i) anucleotide sequence encoding a PCSK9 of said alternative or (ii) anucleotide sequence selected from the group consisting SEQ ID NOs:29-37, whereby a PCSK9 encoded by said nucleotide sequence is targeted.

The ligand can be any anti-PCSK9 ligand disclosed herein.

In a Thirtieth Aspect:

The method of aspect 29, wherein the method comprises targeting a humanPCSK9 selected from the group consisting of forms f c, r, p, m, e, h, ajand q with said ligand to treat and/or prevent said disease or conditionin said human.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In a Thirty-First Aspect:

A method of treating and/or preventing a disease or condition mediatedby PCSK9 in a human, the method comprising targeting (i) a PCSK9 of saidalternative or (ii) a human PCSK9 selected from the group consisting offorms f, c, r, p, m, e, h, aj and q by administering to the human aligand that binds said PCSK9 thereby treating and/or preventing saiddisease or condition in the human.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

The ligand can be any anti-PCSK9 ligand disclosed herein.

In a Thirty-Second Aspect:

The method of aspect 31, wherein the genome of the human comprises anucleotide sequence selected from the group consisting of SEQ ID NOs:29-37.

In an example, the nucleotide sequence is selected from the groupconsisting of SEQ ID NOs: 29-35 and 37; or selected from the groupconsisting of SEQ ID NOs: 29-32 and 34-37; or selected from the groupconsisting of SEQ ID NOs: 29-32, 34, 35 and 37. These arenaturally-occurring allele (haplotype) sequences that do not encode 46Land which meet the criteria set out above. These groups comprisevariants that are associated with elevated LDL-C.

In an example, the nucleotide sequence is SEQ ID NO: 34, that encodes a425S, which is associated with elevated LDL-C (Pisciotta et al 2006).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31 and 37, that encode 670G which is a markerfor severity of coronary atherosclerosis (Chen et al 2005).

In an example, the nucleotide sequence selected from the groupconsisting of SEQ ID NOs: 31, 32, 34, 35, 36 and 37; or selected fromthe group consisting of SEQ ID NOs: 31, 32, 34, 35 and 37. These areallele (haplotype) sequences that have a naturally-occurring combinationof differences from SEQ ID NO: 28 (form a) and which meet the criteriaset out above.

In an example, the nucleotide sequence is SEQ ID NO: 29.

In an example, the nucleotide sequence is SEQ ID NO: 30.

In an example, the nucleotide sequence is SEQ ID NO: 31.

In an example, the nucleotide sequence is SEQ ID NO: 32.

In an example, the nucleotide sequence is SEQ ID NO: 33.

In an example, the nucleotide sequence is SEQ ID NO: 34.

In an example, the nucleotide sequence is SEQ ID NO: 35.

In an example, the nucleotide sequence is SEQ ID NO: 36.

In an example, the nucleotide sequence is SEQ ID NO: 37.

In a Thirty-Third Aspect:

The method of any one of aspects 29 to 32, wherein the human has been oris genotyped as positive for a nucleotide sequence selected from thegroup consisting of SEQ ID NOs: 29-37 or the catalytic- or C-terminaldomain-encoding sequence thereof.

In a Thirty-Fourth Aspect:

The method of any one of aspects 29 to 33, wherein the human has been oris phenotyped as positive for (i) a PCSK9 of said alternative or (ii) ahuman PCSK9 selected from the group consisting of forms f c, r, p, m, e,h, aj and q.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In a Thirty-Fifth Aspect:

The method of any one of aspects 29 to 34, wherein the method comprisesgenotyping the human as positive for (i) a nucleotide sequence encodinga PCSK9 of said alternative or (ii) a nucleotide sequence selected fromthe group consisting of SEQ ID NOs: 29-37 or the catalytic- orC-terminal domain-encoding sequence thereof.

In a Thirty-Sixth Aspect:

The method of any one of aspects 29 to 35, wherein the method comprisesphenotyping the human as positive for (i) a PCSK9 of said alternative or(ii) a human PCSK9 sequence selected from the group consisting of formsf c, r, p, m, e, h, aj and q.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In a Thirty-Seventh Aspect:

The method of any one of aspects 29 to 36, wherein the human has been oris genotyped as heterozygous for said nucleotide sequence of (i) or anucleotide sequence selected from the group consisting of SEQ ID NOs:29-37 or the catalytic- or C-terminal domain-encoding sequence thereof;optionally wherein the human has been or is genotyped as comprising thenucleotide sequence of SEQ ID NO: 28 or the catalytic- or C-terminaldomain-encoding sequence thereof and said nucleotide sequence of (i) ora nucleotide sequence selected from the group consisting of SEQ ID NOs:29-37 or the catalytic- or C-terminal domain-encoding sequence thereof.

In a Thirty-Eighth Aspect:

The method of any one of aspects 29 to 37, wherein the genome of thehuman has been or is genotyped as homozygous for said nucleotidesequence of (i) or a nucleotide sequence selected from the groupconsisting of of SEQ ID NOs: 29-37 or the catalytic- or C-terminaldomain-encoding sequence thereof.

In a Thirty-Ninth Aspect:

The method of any one of aspects 29 to 38, wherein the method comprisesgenotyping the human for said nucleotide sequence of (i) or a nucleotidesequence selected from the group consisting of SEQ ID NOs: 29-37 or thecatalytic- or C-terminal domain-encoding sequence thereof beforeadministering the ligand to the human, wherein the ligand is determinedto be capable of binding to a PCSK9 encoded by said selected sequence.

In a Fortieth Aspect:

The method of any one of aspects 29 to 39, wherein the ligand, human,disease or condition is according to any one of aspects 1 to 19.

In a Forty-First Aspect:

A method according to any one of aspects 29 to 40 for treating and/orpreventing a condition or disease as recited in aspect 14 or 15, themethod comprising administering said ligand and a statin (eg,cerovastatin, atorvastatin, simvastatin, pitavastin, rosuvastatin,fluvastatin, lovastatin or pravastatin) to the human.

In a Forty-Second Aspect:

The method of aspect 41, wherein the ligand and statin are administeredseparately.

In a Forty-Third Aspect:

The method of aspect 41, wherein the ligand and statin are administeredsimultaneously.

In a Forty-Fourth Aspect:

The method of any one of aspects 29 to 43, wherein the ligand isadministered by subcutaneous injection.

In a Forty-Fifth Aspect:

A method of PCSK9 genotyping a nucleic acid sample of a human, themethod comprising identifying in the sample the presence of (i) anucleotide sequence enoding a PCSK9 of said alternative or (ii) anucleotide sequence selected from the group consisting of SEQ ID NOs:29-37 or the catalytic- or C-terminal domain-encoding sequence thereof.

In a Forty-Sixth Aspect:

A method of PCSK9 typing a protein sample of a human, the methodcomprising identifying in the sample the presence of (i) a PCSK9 of saidalternative or (ii) a human PCSK9 selected from the group consisting offorms f c, r, p, m, e, h, aj and q.

In an example, said forms are the mature forms.

In an example, said forms are the pro-forms.

In a Forty-Seventh Aspect:

The method of aspect 45 or 46, comprising obtaining a sample of serum,blood, faeces, hair, tissue, cells, urine or saliva from a human,whereby the nucleic acid or protein sample is obtained and used in thestep of identifying said sequence.

In a Forty-Eighth Aspect:

The method of any one of aspects 45 to 47, comprising using a ligandaccording to any one of aspects 1 to 19 to carry out said identifyingstep.

In a Forty-Ninth Aspect:

A method of treating and/or preventing in a human patient acardiovascular disease or condition, or a disease or condition that isassociated with elevated LDL cholesterol (eg, hypercholesterolaemia),wherein the patient is receiving or has previously received statintreatment for said disease or condition, the method comprising typingthe patient using a method of any one of aspects 45 to 48 andadministering a ligand according to one of aspects 1 to 19 whereby thehuman is treated or said disease or condition is prevented; optionallyalso reducing or stopping statin treatment.

In an example, said reducing or stopping comprises reducing the doseand/or dosing frequency of statin.

In a Fiftieth Aspect:

A diagnostic, therapeutic or prophylactic kit comprising a ligand thatis capable of binding to or has been or is determined as capable ofbinding to an amino acid sequence selected from SEQ ID NOs: 4-27 andinstructions for carrying out the method of any one of aspects 46 to 49and/or a label or instructions indicating or covering administration ofthe ligand to a human as defined in any one of aspects 1 to 19.

In a Fifty-First Aspect:

A diagnostic, therapeutic or prophylactic kit comprising a nucleic acidprobe comprising a nucleotide sequence that specifically hybridises to anucleotide sequence or (i) or a nucleotide sequence selected from thegroup consisting of SEQ ID NOs: 29-37 or an antisense sequence or RNAtranscript thereof and instructions for carrying out the method ofaspect 45, 47 or 48.

In examples of the present invention, the ligand specifically binds tohuman PCSK9, eg, one or more of (i) the PCSK9s of said alternative or(ii) the rare PCSK9 variants disclosed herein (eg, one, two, three, moreor all mature forms f, c, r, p, m, e, h, aj and q) and optionally alsothe a and/or a′ form. For example, the ligand specifically binds tomature form f and/or c as well as form a. For example, the ligandspecifically binds to a human PCSK9 comprising a mutation E670G and alsobinds to a human PCSK9 comprising a mutation I474V, Q619P or N425S inSEQ ID NO: 1. For example, the ligand specifically binds to a humanPCSK9 comprising a mutation E670G and also binds to a human PCSK9comprising a mutation I474V in SEQ ID NO: 1. For example, the ligandspecifically binds to a human PCSK9 comprising a mutation E670G and alsobinds to a human PCSK9 comprising a mutation Q619P in SEQ ID NO: 1. Forexample, the ligand specifically binds to a human PCSK9 comprising amutation E670G and also binds to a human PCSK9 comprising a mutationN425S in SEQ ID NO: 1. Determination of such binding can be performed byany antibody binding test as known in the art, eg, by surface plasmonresonance. Binding to each such form is, for example, respectively witha Kd of at least 1 mM, 100 nM, 1 nM, 100 pM, 1OpM or 1pM.

In an example, the ligand binds form a and (i) a PCSK9 of saidalternative or (ii) a PCSK9 selected from the group consisting of formsf c, r, p, m, e, h, aj and q, wherein the ligand binding to saidselected form is with a Kd (determined by SPR) that is at least 60, 70,80, 90 or 95% of the Kd for binding to form a. In an embodiment, bothforms are mature forms. In an embodiment, both forms are pro-forms.

In an example, the ligand binds form a and form f, wherein the ligandbinding to form f is with a Kd (determined by SPR) that is at least 60,70, 80, 90 or 95% of the Kd for binding to form a. In an embodiment,both forms are mature forms. In an embodiment, both forms are pro-forms.

In an example, the ligand binds form a and form c, wherein the ligandbinding to form c is with a Kd (determined by SPR) that is at least 60,70, 80, 90 or 95% of the Kd for binding to form a. In an embodiment,both forms are mature forms. In an embodiment, both forms are pro-forms.

In an example, the ligand binds form a and form r, wherein the ligandbinding to form r is with a Kd (determined by SPR) that is at least 60,70, 80, 90 or 95% of the Kd for binding to form a. In an embodiment,both forms are mature forms. In an embodiment, both forms are pro-forms.

In an example, the ligand binds form a and form p, wherein the ligandbinding to formp is with a Kd (determined by SPR) that is at least 60,70, 80, 90 or 95% of the Kd for binding to form a. In an embodiment,both forms are mature forms. In an embodiment, both forms are pro-forms.

In an example, the ligand binds form a and form m, wherein the ligandbinding to form m is with a Kd (determined by SPR) that is at least 60,70, 80, 90 or 95% of the Kd for binding to form a. In an embodiment,both forms are mature forms. In an embodiment, both forms are pro-forms.

In an example, the ligand binds form a and form e, wherein the ligandbinding to form e is with a Kd (determined by SPR) that is at least 60,70, 80, 90 or 95% of the Kd for binding to form a. In an embodiment,both forms are mature forms. In an embodiment, both forms are pro-forms.

In an example, the ligand binds form a and form h, wherein the ligandbinding to form h is with a Kd (determined by SPR) that is at least 60,70, 80, 90 or 95% of the Kd for binding to form a. In an embodiment,both forms are mature forms. In an embodiment, both forms are pro-forms.

In an example, the ligand binds form a and form aj, wherein the ligandbinding to form aj is with a Kd (determined by SPR) that is at least 60,70, 80, 90 or 95% of the Kd for binding to form a. In an embodiment,both forms are mature forms. In an embodiment, both forms are pro-forms.

In an example, the ligand binds form a and form q, wherein the ligandbinding to form q is with a Kd (determined by SPR) that is at least 60,70, 80, 90 or 95% of the Kd for binding to form a. In an embodiment,both forms are mature forms. In an embodiment, both forms are pro-forms.

In examples of the present invention, the ligand neutralises humanPCSK9, eg, one or more of the rare PCSK9 variants disclosed herein (eg,one, two, three, more or all mature forms f c, r, p, m, e, h, aj and q)and optionally also the a and/or a′ form. For example, the ligandneutralises mature form f and/or c as well as form a. Determination ofneutralisation can be performed, for example, by any neutralisationassay method disclosed in US20120093818A1 (Amgen, Inc) orUS20110065902A1 (Regeneron Pharmaceuticals, Inc). Ligands of theinvention that bind or target PCSK9 are useful, for example, fortherapeutic and prophylactic applications disclosed in US20120093818A1and US20110065902A1, these specific disclosures being incorporatedherein by reference for use in the present invention and for possibleinclusion in claims herein.

In embodiments where the ligand is used for therapeutic applications, anantigen binding protein can inhibit, interfere with or modulate one ormore biological activities of a PCSK9 (eg, one or more of the rarevariants disclosed herein and optionally also the a and/or a′ form). Inone embodiment, ligand binds specifically to human PCSK9 (eg, one ormore of the rare variants disclosed herein and optionally also the aand/or a′ form) and/or substantially inhibits binding of human PCSK9(eg, said one or more of the rare variants disclosed herein andoptionally also the a and/or a′ form) to LDLR by at least 20%, eg,20%-40%, 40-60%, 60-80%, 80-85%, or more (for example, by measuringbinding in an in vitro competitive binding assay). In an example, theligand is an antibody.

In an embodiment, the ligand has a Kd of less (binding more tightly)than 10⁻⁷, 10⁻⁸, 10⁻⁹, 10⁻¹⁰, 10⁻¹¹, 10⁻¹², 10⁻¹³ M for binding to one,two or more of the rare variants disclosed herein and optionally alsothe a and/or a′ form. In an example, Kd is determined using SPR.

In an embodiment, the ligand has an IC50 for blocking the binding ofLDLR to one or more of the rare PCSK9 variants disclosed herein (andoptionally also the a and/or a′ form) of less than 1 microM, 1000 nM to100 nM, 100 nM to 10 nM, 10 nM to 1 nM, 1000 pM to 500 pM, 500 pM to 200pM, less than 200 pM, 200 pM to 150 pM, 200 pM to 100 pM, 100 pM to 10pM, 10 pM to 1 pM.

In an embodiment, the ligand has an IC50 for blocking the binding ofLDLR to the a and/or a′ form of PCSK9 that is no more than 1000, 100,90, 80, 70, 60, 50, 40, 30, 20 or 10-fold more (ie, more inhibitory)than the IC50 for blocking the binding of LDLR to one or more of therare PCSK9 variants disclosed herein (eg, one or more PCSK9 proteinscomprising a sequence selected from SEQ ID NOs: 4 to 27). Additionallyor alternatively, for example, the ligand has an IC50 for blocking thebinding of LDLR to (i) the a and/or a′ form of less than 1 microM, 1000nM to 100 nM, 100 nM to 10 nM, 10 nM to 1 nM, 1000 pM to 500 pM, 500 pMto 200 pM, less than 200 pM, 200 pM to 150 pM, 200 pM to 100 pM, 100 pMto 10 pM, 10 pM to 1 pM, eg, in the range of 1 mM to 1pM (eg, 1 mM to100 pM; 10 nM to 100 pM; 1 nM to 10 pM; or 100 pM to 1pM) and (ii) oneor more PCSK9 proteins comprising a sequence selected from SEQ ID NOs: 4to 27 of less than 1 microM, 1000 nM to 100 nM, 100 nM to 10 nM, 10 nMto 1 nM, 1000 pM to 500 pM, 500 pM to 200 pM, less than 200 pM, 200 pMto 150 pM, 200 pM to 100 pM, 100 pM to 10 pM, 10 pM to 1 pM, eg, in therange of 1 mM to 1pM (eg, 1 mM to 100 pM; 10 nM to 100 pM; 1 nM to 10pM; or 100 pM to 1pM).

In an embodiment, the ligand binds to the a and/or a′ form of PCSK9 witha binding affinity (Kd) that is greater than up to 10%, greater than upto 20%, greater than up to 40%, greater than up to 50%, greater than upto 55%, greater than up to 60%, greater than up to 65%, greater than upto 70%, greater than up to 75%, greater than up to 80%, greater than upto 85%, greater than up to 90%, greater than up to 95% or greater thanup to 100% (ie, is double) relative to binding to a PCSK9 comprising asequence selected from SEQ ID NOs: 4 to 27. Such binding measurementscan be made using a variety of binding assays known in the art, eg,using surface plasmon resonance (SPR), such as by Biacore™ or using theProteOn XPR36™ (Bio-Rad®), or using KinExA® (Sapidyne Instruments, Inc).

In one embodiment, the surface plasmon resonance (SPR) is carried out at25° C. In another embodiment, the SPR is carried out at 37° C.

In one embodiment, the SPR is carried out at physiological pH, such asabout pH7 or at pH7.6 (eg, using Hepes buffered saline at pH7.6 (alsoreferred to as HBS-EP)).

In one embodiment, the SPR is carried out at a physiological salt level,eg, 150 mM NaCl.

In one embodiment, the SPR is carried out at a detergent level of nogreater than 0.05% by volume, eg, in the presence of P20 (polysorbate20; eg, Tween-20TM) at 0.05% and EDTA at 3 mM.

In one example, the SPR is carried out at 25° C. or 37° C. in a bufferat pH7.6, 150 mM NaCl, 0.05% detergent (eg, P20) and 3 mM EDTA. Thebuffer can contain 10 mM Hepes. In one example, the SPR is carried outat 25° C. or 37° C. in HBS-EP. HBS-EP is available from Teknova Inc(California; catalogue number H8022).

In an example, the affinity of the ligand which is an antibody isdetermined using SPR by

1. Coupling anti-mouse (or other relevant vertebrate) IgG (eg, BiacoreBR-1008-38) to a biosensor chip (eg, GLM chip) such as by primary aminecoupling;

2. Exposing the anti-mouse IgG (vertebrate antibody) to a test IgGantibody to capture test antibody on the chip;

3. Passing the test antigen over the chip's capture surface at 1024 nM,256 nM, 64 nM, 16 nM, 4 nM with a 0 nM (i.e. buffer alone); and

4. And determining the affinity of binding of test antibody to testantigen using surface plasmon resonance, eg, under an SPR conditiondiscussed above (eg, at 25° C. in physiological buffer). SPR can becarried out using any standard SPR apparatus, such as by Biacore™ orusing the ProteOn XPR36™ (Bio-Rad®).

Regeneration of the capture surface can be carried out with 10 mMglycine at pH1.7. This removes the captured antibody and allows thesurface to be used for another interaction. The binding data can befitted to 1:1 model inherent using standard techniques, eg, using amodel inherent to the ProteOn XPR36™ analysis software.

In an embodiment, assaying or testing of a ligand of the invention iscarried out at or substantially at pH7 (eg, for in vitro tests andassays) and at or substantially at rtp.

One example of an IgG2 heavy chain constant domain of an anti-PCSK9antibody of the present invention has the amino acid sequence as shownin SEQ ID NO: 154, FIG. 3KK of US20120093818A1, which sequence isincorporated herein by reference.

One example of an IgG4 heavy chain constant domain of an anti-PCSK9antibody of the present invention has the amino acid sequence as shownin SEQ ID NO: 155, FIG. 3KK of US20120093818A1, which sequence isincorporated herein by reference.

One example of a kappa light chain constant domain of an anti-PCSK9antibody has the amino acid sequence as shown in SEQ ID NO: 157, FIG.3KK which sequence is incorporated herein by reference.

One example of a lambda light chain constant domain of an anti-PCSK9antibody has the amino acid sequence as shown in SEQ ID NO: 156, FIG.3KK of US20120093818A1, which sequence is incorporated herein byreference.

In examples of the present invention, the ligand binds mature PCSK9, eg,a mature form of one or more of the rare variants disclosed herein andoptionally also the a and/or a′ form.

In examples of the present invention, the ligand binds the catalyticdomain of PCSK9, eg, of a mature form of one or more of the rarevariants disclosed herein and optionally also the a and/or a′ form.

In examples of the present invention, the ligand binds the prodomain ofPCSK9, eg, of a mature form of one or more of the rare variantsdisclosed herein and optionally also the a and/or a′ form.

In some embodiments, the ligand binds to the V domain of PCSK9, eg, of amature form of one or more of the rare variants disclosed herein andoptionally also the a and/or a′ form. In some embodiments, the ligandbinds to the V domain of PCSK9 (eg, of a mature form of one or more ofthe rare variants disclosed herein and optionally also the a and/or a′form) and prevents (or reduces, eg, by at least 10%) PCSK9 from bindingto LDLR. In some embodiments, the ligand binds to the V domain of PCSK9(eg, of a mature form of one or more of the rare variants disclosedherein and optionally also the a and/or a′ form), and while it does notprevent (or reduce) the binding of PCSK9 to LDLR, the ligand prevents orreduces (eg, by at least 10%) the adverse activities mediated throughPCSK9 on LDLR.

In examples of the present invention, the ligand is or comprises a fullyhuman antibody. In an example, the ligand comprises human variableregions or humanised variable regions.

In an example, the ligand of the invention specifically binds to anepitope of (i) a PCSK9 of said alternative or (ii) a human PCSK9selected from the group consisting of forms f, c, i p, m, e, h, aj andq, wherein the epitope comprises at least one amino acid that is notfound in form a. For example, the amino acid is selected from the groupconsisting of 46L, 53V, 425S, 443T, 474V, 619P and 670G (numbering asused in SEQ ID NO:1). For example, the amino acid is selected from thegroup consisting of 425S, 443T, 474V, 619P and 670G (numbering as usedin SEQ ID NO:1). For example, the amino acid is selected from the groupconsisting of 425S and 443T (numbering as used in SEQ ID NO:1). Forexample, the amino acid is selected from the group consisting of 474V,619P and 670G (numbering as used in SEQ ID NO:1). In an example, thePCSK9 form is the mature form. In an example, the PCSK9 form is thepro-form. In an example, the ligand also specifically binds to form aand/or a′. In an embodiment, the ligand specifically binds to an epitopeof form f PCSK9, wherein the epitope comprises at least one amino acidthat is not found in form a. In an embodiment, the ligand specificallybinds to an epitope of form c PCSK9, wherein the epitope comprises atleast one amino acid that is not found in form a. In an embodiment, theligand specifically binds to an epitope of form r PCSK9, wherein theepitope comprises at least one amino acid that is not found in form a.In an embodiment, the ligand specifically binds to an epitope of form pPCSK9, wherein the epitope comprises at least one amino acid that is notfound in form a. In an embodiment, the ligand specifically binds to anepitope of form m PCSK9, wherein the epitope comprises at least oneamino acid that is not found in form a. In an embodiment, the ligandspecifically binds to an epitope of form e PCSK9, wherein the epitopecomprises at least one amino acid that is not found in form a. In anembodiment, the ligand specifically binds to an epitope of form h PCSK9,wherein the epitope comprises at least one amino acid that is not foundin form a. In an embodiment, the ligand specifically binds to an epitopeof form aj PCSK9, wherein the epitope comprises at least one amino acidthat is not found in form a. In an embodiment, the ligand specificallybinds to an epitope of form q PCSK9, wherein the epitope comprises atleast one amino acid that is not found in form a.

In an embodiment, ligand binds specifically to the pro-domain of a humanPCSK9 selected from the group consisting of forms f c, r, p, m, e, h, ajand q. In an example, the ligand also specifically binds to thepro-domain of form a and/or a′. In an embodiment, the ligandspecifically binds to the pro-domain of form f PCSK9, wherein theepitope comprises at least one amino acid that is not found in form a.In an embodiment, the ligand specifically binds to the pro-domain ofform c PCSK9, wherein the epitope comprises at least one amino acid thatis not found in form a. In an embodiment, the ligand specifically bindsto the pro-domain of form r PCSK9, wherein the epitope comprises atleast one amino acid that is not found in form a. In an embodiment, theligand specifically binds to the pro-domain of form p PCSK9, wherein theepitope comprises at least one amino acid that is not found in form a.In an embodiment, the ligand specifically binds to the pro-domain ofform m PCSK9, wherein the epitope comprises at least one amino acid thatis not found in form a. In an embodiment, the ligand specifically bindsto the pro-domain of form e PCSK9, wherein the epitope comprises atleast one amino acid that is not found in form a. In an embodiment, theligand specifically binds to the pro-domain of form h PCSK9, wherein theepitope comprises at least one amino acid that is not found in form a.In an embodiment, the ligand specifically binds to the pro-domain ofform aj PCSK9, wherein the epitope comprises at least one amino acidthat is not found in form a. In an embodiment, the ligand specificallybinds to the pro-domain of form q PCSK9, wherein the epitope comprisesat least one amino acid that is not found in form a.

In an embodiment, ligand binds specifically to the catalytic domain of ahuman PCSK9 selected from the group consisting of forms f c, r, p, m, e,h, aj and q. In an example, the ligand also specifically binds to thecatalytic domain of form a and/or a′. In an embodiment, the ligandspecifically binds to the catalytic domain of form f PCSK9, wherein theepitope comprises at least one amino acid that is not found in form a.In an embodiment, the ligand specifically binds to the catalytic domainof form c PCSK9, wherein the epitope comprises at least one amino acidthat is not found in form a. In an embodiment, the ligand specificallybinds to the catalytic domain of form r PCSK9, wherein the epitopecomprises at least one amino acid that is not found in form a. In anembodiment, the ligand specifically binds to the catalytic domain ofform p PCSK9, wherein the epitope comprises at least one amino acid thatis not found in form a. In an embodiment, the ligand specifically bindsto the catalytic domain of form m PCSK9, wherein the epitope comprisesat least one amino acid that is not found in form a. In an embodiment,the ligand specifically binds to the catalytic domain of form e PCSK9,wherein the epitope comprises at least one amino acid that is not foundin form a. In an embodiment, the ligand specifically binds to thecatalytic domain of form h PCSK9, wherein the epitope comprises at leastone amino acid that is not found in form a. In an embodiment, the ligandspecifically binds to the catalytic domain of form aj PCSK9, wherein theepitope comprises at least one amino acid that is not found in form a.In an embodiment, the ligand specifically binds to the catalytic domainof form q PCSK9, wherein the epitope comprises at least one amino acidthat is not found in form a.

In an embodiment, ligand binds specifically to the C-terminal domain ofa human PCSK9 selected from the group consisting of forms f c, r, p, m,e, h, aj and q. In an example, the ligand also specifically binds to theC-terminal domain of form a and/or a′. In an embodiment, the ligandspecifically binds to the C-terminal domain of form f PCSK9, wherein theepitope comprises at least one amino acid that is not found in form a.In an embodiment, the ligand specifically binds to the C-terminal domainof form c PCSK9, wherein the epitope comprises at least one amino acidthat is not found in form a. In an embodiment, the ligand specificallybinds to the C-terminal domain of form r PCSK9, wherein the epitopecomprises at least one amino acid that is not found in form a. In anembodiment, the ligand specifically binds to the C-terminal domain ofform p PCSK9, wherein the epitope comprises at least one amino acid thatis not found in form a. In an embodiment, the ligand specifically bindsto the C-terminal domain of form m PCSK9, wherein the epitope comprisesat least one amino acid that is not found in form a. In an embodiment,the ligand specifically binds to the C-terminal domain of form e PCSK9,wherein the epitope comprises at least one amino acid that is not foundin form a. In an embodiment, the ligand specifically binds to theC-terminal domain of form h PCSK9, wherein the epitope comprises atleast one amino acid that is not found in form a. In an embodiment, theligand specifically binds to the C-terminal domain of form aj PCSK9,wherein the epitope comprises at least one amino acid that is not foundin form a. In an embodiment, the ligand specifically binds to theC-terminal domain of form q PCSK9, wherein the epitope comprises atleast one amino acid that is not found in form a.

In an embodiment, ligand binds specifically to the substrate-bindinggroove of a human PCSK9 selected from the group consisting of forms f c,r, p, m, e, h, aj and q (see Cunningham et al., Nat Struct Mol Biol.2007 May; 14(5):413-9. Epub 2007 Apr. 15, “Structural and biophysicalstudies of PCSK9 and its mutants linked to familialhypercholesterolemia”, incorporated herein in its entirety byreference). In an example, the ligand also specifically binds to thesubstrate-binding groove of form a and/or a′. In an embodiment, theligand specifically binds to the Substrate-binding groove of form fPCSK9, wherein the epitope comprises at least one amino acid that is notfound in form a. In an embodiment, the ligand specifically binds to theSubstrate-binding groove of form c PCSK9, wherein the epitope comprisesat least one amino acid that is not found in form a. In an embodiment,the ligand specifically binds to the Substrate-binding groove of form rPCSK9, wherein the epitope comprises at least one amino acid that is notfound in form a. In an embodiment, the ligand specifically binds to theSubstrate-binding groove of form p PCSK9, wherein the epitope comprisesat least one amino acid that is not found in form a. In an embodiment,the ligand specifically binds to the Substrate-binding groove of form mPCSK9, wherein the epitope comprises at least one amino acid that is notfound in form a. In an embodiment, the ligand specifically binds to theSubstrate-binding groove of form e PCSK9, wherein the epitope comprisesat least one amino acid that is not found in form a. In an embodiment,the ligand specifically binds to the Substrate-binding groove of form hPCSK9, wherein the epitope comprises at least one amino acid that is notfound in form a. In an embodiment, the ligand specifically binds to theSubstrate-binding groove of form aj PCSK9, wherein the epitope comprisesat least one amino acid that is not found in form a. In an embodiment,the ligand specifically binds to the Substrate-binding groove of form qPCSK9, wherein the epitope comprises at least one amino acid that is notfound in form a.

Reference is made to US20120093818A1 (Amgen, Inc), the entire disclosureof which is incorporated herein. This patent application disclosesrelevant ligands for use in the present invention, as well as examplesand methods of producing and testing ligands that can be used withreference to the present invention.

In an example, the ligand is or comprises an antibody disclosed in Table2 of US20120093818A1 (Amgen, Inc) or is a PCSK9-binding derivativethereof.

In an embodiment, the PCSK9-binding ligand of the invention is selectedfrom the antigen binding proteins disclosed in US20120093818A1 (Amgen,Inc), eg, in paragraphs [0009] to and [0058] to [0063] ofUS20120093818A1; all of these disclosures (including the sequences ofsuch proteins) are incorporated herein by reference as though explicitlyrecited herein and for possible inclusion in one or more claims or foruse in the present invention.

In this paragraph SEQ ID NOs are those as appearing in US20120093818A1(Amgen, Inc) and these sequences are incorporated herein by reference asthough explicitly recited herein and for possible inclusion in one ormore claims or for use in the present invention. In some aspects, theligand of the invention comprises an isolated antigen binding proteinthat binds PCSK9 comprising: A) one or more heavy chain complementarydetermining regions (CDRHs) selected from the group consisting of: (i) aCDRH1 from a CDRH1 in a sequence selected from the group consisting ofSEQ ID NO: 74, 85, 71, 72, 67, 87, 58, 52, 51, 53, 48, 54, 55, 56, 49,57, 50, 91, 64, 62, 89, 65, 79, 80, 76, 77, 78, 83, 69, 81, and 60; (ii)a CDRH2 from a CDRH2 in a sequence selected from the group consisting ofSEQ ID NO: 74, 85, 71, 72, 67, 87, 58, 52, 51, 53, 48, 54, 55, 56, 49,57, 50, 91, 64, 62, 89, 65, 79, 80, 76, 77, 78, 83, 69, 81, and 60;(iii) a CDRH3 from a CDRH3 in a sequence selected from the groupconsisting of SEQ ID NO: 74, 85, 71, 72, 67, 87, 58, 52, 51, 53, 48, 54,55, 56, 49, 57, 50, 91, 64, 62, 89, 65, 79, 80, 76, 77, 78, 83, 69, 81,and 60; and (iv) a CDRH of (i), (ii), and (iii) that contains one ormore amino acid substitutions, deletions or insertions of no more than 4amino acids; B) one or more light chain complementary determiningregions (CDRLs) selected from the group consisting of: (i) a CDRL1 froma CDRL1 in a sequence selected from the group consisting of SEQ ID NO:5, 7, 9, 10, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30,31, 32, 33, 35, 36, 37, 38, 39, 40, 42, 44, and 46; (ii) a CDRL2 from aCDRL2 in a sequence selected from the group consisting of SEQ ID NO: 5,7, 9, 10, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30,31, 32, 33, 35, 36, 37, 38, 39, 40, 42, 44, and 46; (iii) a CDRL3 from aCDRL3 in a sequence selected from the group consisting of SEQ ID NO: 5,7, 9, 10, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30,31, 32, 33, 35, 36, 37, 38, 39, 40, 42, 44, and 46; and (iv) a CDRL of(i), (ii) and (iii) that contains one or more amino acid substitutions,deletions or insertions of no more than 4 amino acids; or C) one or moreheavy chain CDRHs of A) and one or more light chain CDRLs of B). In someembodiments, the isolated antigen binding protein comprises at least oneCDRH of A) and at least one CDRL of B). In some embodiments, theisolated antigen binding protein comprises at least two CDRH of A) andat least two CDRL of B). In some embodiments, the isolated antigenbinding protein comprises said CDRH1, CDRH2, CDRH3, CDRL1, CDRL2 andCDRL3. In some embodiments, the CDRH of A) is selected from at least oneof the group consisting of: (i) a CDRH1 amino acid sequence selectedfrom the CDRH1 in a sequence selected from the group consisting of SEQID NO: 67, 79, 89, and 49; (ii) a CDRH2 amino acid sequence selectedfrom the CDRH2 in a sequence selected from the group consisting of SEQID NO: 67, 79, 89, and 49; (iii) a CDRH3 amino acid sequence selectedfrom the CDRH3 in a sequence selected from the group consisting of SEQID NO: 67, 79, 89, and 49; and (iv) a CDRH of (i), (ii) and (iii) thatcontains one or more amino acid substitutions, deletions or insertionsof no more than 2 amino acids. In addition, the CDRL of B) is selectedfrom at least one of the group consisting of: (i) a CDRL1 amino acidsequence selected from the CDRL1 in a sequence selected from the groupconsisting of SEQ ID NO: 12, 35, 32, and 23; (ii) a CDRL2 amino acidsequence selected from the CDRL2 in a sequence selected from the groupconsisting of SEQ ID NO: 12, 35, 32, and 23; (iii) a CDRL3 amino acidsequence selected from the CDRL3 in a sequence selected from the groupconsisting of SEQ ID NO: 12, 35, 32, and 23; and (iv) a CDRL of (i),(ii) and (iii) that contains one or more amino acid substitutions,deletions or insertions of no more than 2 amino acids; or C) one or moreheavy chain CDRHs of A) and one or more light chain CDRLs of B. In someembodiments, the CDRH of A) is selected from at least one of the groupconsisting of: (i) a CDRH1 amino acid sequence of the CDRH1 amino acidsequence in SEQ ID NO: 67; (ii) a CDRH2 amino acid sequence of the CDRH2amino acid sequence in SEQ ID NO: 67; (iii) a CDRH3 amino acid sequenceof the CDRH3 amino acid sequence in SEQ ID NO: 67; and (iv) a CDRH of(i), (ii) and (iii) that contains one or more amino acid substitutions,deletions or insertions of no more than 2 amino acids; said CDRL of B)is selected from at least one of the group consisting of: (i) a CDRL1amino acid sequence of the CDRL1 amino acid sequence in SEQ ID NO: 12;(ii) a CDRL2 amino acid sequence of the CDRL2 amino acid sequence in SEQID NO: 12; (iii) a CDRL3 amino acid sequence of the CDRL3 amino acidsequence in SEQ ID NO: 12; and (iv) a CDRL of (i), (ii) and (iii) thatcontains one or more amino acid substitutions, deletions or insertionsof no more than 2 amino acids; or C) one or more heavy chain CDRHs of A)and one or more light chain CDRLs of B). In some embodiments, theantigen binding protein comprises A) a CDRH1 of the CDRH1 sequence inSEQ ID NO: 67, a CDRH2 of the CDRH2 sequence in SEQ ID NO: 67, and aCDRH3 of the CDRH3 sequence in SEQ ID NO: 67, and B) a CDRL1 of theCDRL1 sequence in SEQ ID NO: 12, a CDRL2 of the CDRL2 sequence in SEQ IDNO: 12, and a CDRL3 of the CDRL3 sequence in SEQ ID NO: 12. In someembodiments, the antigen binding protein comprises a heavy chainvariable region (VH) having at least 80% sequence identity with an aminoacid sequence selected from the group consisting of SEQ ID NO: 74, 85,71, 72, 67, 87, 58, 52, 51, 53, 48, 54, 55, 56, 49, 57, 50, 91, 64, 62,89, 65, 79, 80, 76, 77, 78, 83, 69, 81, and 60, and/or a light chainvariable region (VL) having at least 80% sequence identity with an aminoacid sequence selected from the group consisting of SEQ ID NO: 5, 7, 9,10, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30, 31, 32,33, 35, 36, 37, 38, 39, 40, 42, 44, and 46. In some embodiments, the VHhas at least 90% sequence identity with an amino acid sequence selectedfrom the group consisting of SEQ ID NO: 74, 85, 71, 72, 67, 87, 58, 52,51, 53, 48, 54, 55, 56, 49, 57, 50, 91, 64, 62, 89, 65, 79, 80, 76, 77,78, 83, 69, 81, and 60, and/or the VL has at least 90% sequence identitywith an amino acid sequence selected from the group consisting of SEQ IDNO: 5, 7, 9, 10, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 28,30, 31, 32, 33, 35, 36, 37, 38, 39, 40, 42, 44, and 46. In someembodiments, the VH is selected from the group consisting of SEQ ID NO:74, 85, 71, 72, 67, 87, 58, 52, 51, 53, 48, 54, 55, 56, 49, 57, 50, 91,64, 62, 89, 65, 79, 80, 76, 77, 78, 83, 69, 81, and 60, and/or the VL isselected from the group consisting of SEQ ID NO: 5, 7, 9, 10, 12, 13,15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30, 31, 32, 33, 35, 36,37, 38, 39, 40, 42, 44, and 46.

In an example of any aspect of the invention, the PCSK9-targeting orbinding ligand comprises or consists of AMG145 or 31H4, 16F12, 11F1, 8A3or 21B12 disclosed in US20120093818A1 (Amgen, Inc) or an antibodycomprising the variable domains of AMG145, 31H4, 16F12, 11F1, 8A3 or21B12, the disclosures of which (including sequences) are incorporatedherein by reference as though explicitly recited herein and for possibleinclusion in one or more claims or for use in the present invention.Preferably, the PCSK9-targeting or binding ligand comprises or consistsof AMG145.

In an example, the AMG145 or other ligand of the invention isglycosylated, eg, has human glycosylation (eg, produced by a CHO, Cos orHek293 cell). In an example, the ligand of the invention is produced inCHO.

Reference is made to US20110065902A1 (Regeneron Pharmaceuticals, Inc),the entire disclosure of which is incorporated herein. This patentapplication discloses relevant ligands for use in the present invention,as well as examples and methods of producing and testing ligands anddetermining medical efficacy that can be used with reference to thepresent invention.

Reference is made to the following PCT applications, the entiredisclosures of which are incorporated herein. These disclose relevantligands for use in the present invention, as well as examples andmethods of producing and testing ligands and determining medicalefficacy that can be used with reference to the present invention.

WO2008057457

WO2008057458

WO2008057459

WO2008063382

WO2008133647

WO2009100297

WO2009100318

WO2011037791

WO2011053759

WO2011053783

WO2008125623

WO2011072263

WO2009055783

WO2010029513

WO2011111007

WO2010077854

Antibody ligands to PCSK9 are described in, for example, WO 2008/057457,WO 2008/057458, WO 2008/057459, WO 2008/063382, WO 2008/125623, and US2008/0008697; each of which is incorporated by reference herein in itsentirety.

In an example, the ligand is or comprises an antibody disclosed in theExamples of US20110065902A1 (eg, 316P or 300N) or is a PCSK9-bindingderivative thereof. All of these disclosures (including the sequences ofsuch proteins and corresponding nucleotide sequences) are incorporatedherein by reference as though explicitly recited herein and for possibleinclusion in one or more claims or for use in the present invention. Inan embodiment, the ligand is or comprises the variable domains ofantibody 316P or 300N disclosed in US20110065902A1 or is (or comprises)such antibody or a PCSK9-binding derivative thereof.

In an embodiment, the ligand is or comprises the variable domains ofantibody alirocumab or SAR236553/REGN727 (Sanofi Aventis/Regeneron) oris (or comprises) such antibody or a PCSK9-binding derivative thereof.In an example, the alirocumab is glycosylated, eg, has humanglycosylation (eg, produced by a CHO, Cos or Hek293 cell). Preferably,the ligand is alirocumab or SAR236553/REGN727.

In an embodiment, the ligand is or comprises the variable domains ofantibody evolocumab or or is (or comprises) such antibody or aPCSK9-binding derivative thereof. In an example, the antibody isglycosylated, eg, has human glycosylation (eg, produced by a CHO, Cos orHek293 cell). Preferably, the ligand is evolocumab.

In an embodiment, the ligand is selected from evolocumab, 1D05-IgG2(Merck & Co.), ALN-PCS02 (Alnylam), RN316 (Pfizer-Rinat) and alirocumab.

In an embodiment, the ligand is selected from the following (sequencesand definitions as per US2011/0065902, incorporated herein byreference):—

1. An antibody or antigen-binding fragment thereof which specificallybinds hPCSK9, wherein the antibody or antigen-binding fragment comprisesthe heavy and light chain CDRs of a HCVR/LCVR amino acid sequence pairhaving SEQ ID NOs: 218/226.

2. The antibody or antigen-binding fragment of concept 1 comprisingheavy and light chain CDR amino acid sequences having SEQ ID NOs: 220,222, 224, 228, 230 and 232.

3. The antibody or antigen-binding fragment of concept 2 comprising anHCVR having the amino acid sequence of SEQ ID NO: 218 and an LCVR havingthe amino acid sequence of SEQ ID NO: 226.

4. An antibody or antigen-binding fragment thereof which binds to thesame epitope on hPCSK9 as an antibody comprising heavy and light chainCDR amino acid sequences having SEQ ID NOs: 220, 222, 224, 228, 230 and232.

5. An antibody or antigen-binding fragment thereof which competes forbinding to hPCSK9 with an antibody comprising heavy and light chain CDRamino acid sequences having SEQ ID NOs: 220, 222, 224, 228, 230 and 232.

In an embodiment, the ligand is selected from the following (sequencesand definitions as per US2012/0093818, incorporated herein byreference):—

1. An isolated neutralizing antigen binding protein that binds to aPCSK9 protein comprising the amino acid sequence of SEQ ID NO: 1,wherein the neutralizing antigen binding protein decreases the LDLRlowering effect of PCSK9 on LDLR, wherein the antigen binding proteincomprises a light chain comprising an amino acid sequence of SEQ ID NO:46, and wherein the antigen binding protein comprises a heavy chaincomprising an amino acid sequence of SEQ ID NO: 60.2. The isolated neutralizing antigen binding protein of concept 2,wherein the antigen binding protein is a LDLR non-competitiveneutralizing antigen binding protein.3. The isolated neutralizing antigen binding protein of concept 2,wherein the antigen binding protein is a LDLR competitive neutralizingantigen binding protein.4. An antigen binding protein that selectively binds to PCSK9, whereinsaid antigen binding protein binds to PCSK9 with a Kd that is less than100 pM.5. An antigen binding protein that binds to a PCSK 9 protein of SEQ IDNO: 303 in a first manner, wherein the antigen binding protein binds toa variant of PCSK9 in a second manner, wherein said PCSK9 variant has atleast one point mutation at a position selected from the groupconsisting of: 207, 208, 185, 181, 439, 513, 538, 539, 132, 351, 390,413, 582, 162, 164, 167, 123, 129, 311, 313, 337, 519, 521, and 554 ofSEQ ID NO: 303, wherein the first manner comprises a first EC50, a firstBmax, or a first EC50 and a first Bmax, wherein the second mannercomprises a second EC50, a second Bmax, or a second EC50 and a secondBmax, and wherein a value for the first manner is different from a valuefor the second manner, and wherein the antigen binding protein comprisesa light chain comprising an amino acid sequence of SEQ ID NO: 46, andwherein the antigen binding protein comprises a heavy chain comprisingan amino acid sequence of SEQ ID NO: 60.6. The antigen binding protein of concept 6, wherein the first mannercomprises a first Bmax, wherein the second manner comprises a secondBmax that is different from the first Bmax, and wherein said PCSK9variant has at least one point mutation selected from the groupconsisting of: D162R, R164E, E167R, S123R, E129R, A311R, D313R, D337R,R519E, H521R, and Q554R.7. The antigen binding protein of concept 6, wherein the antigen bindingprotein binds to PCSK9 at a location that overlaps with a location thatLDLR binds to PCSK9.8. A method of making an antigen binding protein that binds to a PCSK9protein comprising the amino acid sequence of SEQ ID NO: 1, wherein theantigen binding protein decreases the LDLR lowering effect of PCSK9 onLDLR, said method comprising:providing a host cell comprising a nucleicacid sequence that encodes the antigen binding protein; and maintainingthe host cell under conditions in which the antigen binding protein isexpressed, wherein the antigen binding protein comprises a light chaincomprising an amino acid sequence of SEQ ID NO: 46, and wherein theantigen binding protein comprises a heavy chain comprising an amino acidsequence of SEQ ID NO: 60.9. A method for treating or preventing a condition associated withelevated serum cholesterol levels in a subject, said method comprisingadministering to a subject in need thereof an effective amount of anisolated neutralizing antigen binding protein simultaneously orsequentially with an agent that elevates the availability of LDLRprotein, wherein the isolated antigen binding protein binds to a PCSK9protein comprising the amino acid sequence of SEQ ID NO: 1, wherein theneutralizing antigen binding protein decreases the LDLR lowering effectof PCSK9 on LDLR, wherein the antigen binding protein comprises a lightchain comprising an amino acid sequence of SEQ ID NO: 46, and whereinthe antigen binding protein comprises a heavy chain comprising an aminoacid sequence of SEQ ID NO: 60.10. The method of concept 10, wherein the agent that elevates theavailability of LDLR protein comprises a statin.11. An antigen binding protein that binds to PCSK9, wherein when theantigen binding protein is bound to PCSK9, the antibody is positioned 8angstroms or less from at least one of the following residues of PCSK9:S153, S188, I189, Q190, S191, D192, R194, E197, G198, R199, V200, D224,R237, D238, K243, S373, D374, S376, T377, F379, I154, T187, H193, E195,I196, M201, V202, C223, T228, S235, G236, A239, G244, M247, I369, S372,C375, or C378, wherein the antigen binding protein comprises a lightchain comprising an amino acid sequence of SEQ ID NO: 46, and whereinthe antigen binding protein comprises a heavy chain comprising an aminoacid sequence of SEQ ID NO: 60.

The ligand can be used for the treatment, therapy, prophylaxis and/ordiagnosis of one or more diseases or conditions or susceptibilitythereto, wherein such diseases or conditions comprise those disclosed inUS20120093818A1 (Amgen, Inc) and US20110065902A1 (RegeneronPharmaceuticals, Inc), eg, a disease or condition disclosed inparagraphs [0375] to [0383] of US20120093818A1, which disclosure isincorporated herein by reference in its entirety for inclusion in onemore claims herein.

The ligand can be administered to a human characterised as described inUS20120093818A1 (Amgen, Inc) or US20110065902A1.

The ligand can be administered in a form or combination disclosed inUS20120093818A1 (Amgen, Inc) or US20110065902A1, which disclosure isincorporated herein by reference. For example, the ligand with a drug,excipient, diluent or carrier as described in US20120093818A1 (Amgen,Inc) or US20110065902A1 (eg, as disclose in paragraphs [0384] to [0412]of US20120093818A1), which disclosure is incorporated herein byreference, and the present invention also relates to the correspondingpharmaceutical compositions comprising the combination of a ligand ofthe invention and such a further agent.

The ligand can be used in a method of diagnosis as set out inUS20120093818A1 (Amgen, Inc) or US20110065902A1, eg, in paragraphs[0413] to [0415] of US20120093818A1 which disclosure is incorporatedherein by reference.

Diagnostic Applications

In some embodiments, the ligand of the invention is a diagnostic tool.The ligand can be used to assay the amount of PCSK9 present in a sampleand/or subject. As will be appreciated by one of skill in the art, suchligands need not be neutralizing ligands. In some embodiments, thediagnostic ligand is not a neutralizing ligand. In some embodiments, thediagnostic ligand binds to a different epitope than a neutralizingligand binds to. In some embodiments, the two ligands do not competewith one another.

In some embodiments, the ligands of the invention are used or providedin an assay kit and/or method for the detection of PCSK9 in mammaliantissues or cells in order to screen/diagnose for a disease or disorderassociated with changes in levels of PCSK9. The kit comprises a ligandthat binds PCSK9 and means for indicating the binding of the ligand withPCSK9, if present, and optionally PCSK9 protein levels. Various meansfor indicating the presence of a ligand can be used. For example,fluorophores, other molecular probes, or enzymes can be linked to theligand and the presence of the ligand can be observed in a variety ofways. The method for screening for such disorders can involve the use ofthe kit, or simply the use of one of the disclosed ligands and thedetermination of whether the ligand binds to PCSK9 in a sample. As willbe appreciated by one of skill in the art, high or elevated levels ofPCSK9 will result in larger amounts of the ligand binding to PCSK9 inthe sample. Thus, degree of ligand binding can be used to determine howmuch PCSK9 is in a sample. Subjects or samples with an amount of PCSK9that is greater than a predetermined amount (e.g., an amount or rangethat a person without a PCSK9 related disorder would have) can becharacterized as having a PCSK9 mediated disorder. In some embodiments,the invention provides a method wherein the ligand is administered to asubject taking a statin, in order to determine if the statin hasincreased the amount of PCSK9 in the subject.

In some embodiments, the ligand is a non-neutralizing ligand and is usedto determine the amount of PCSK9 in a subject receiving an ABP and/orstatin treatment.

In some embodiments, the ligand of the invention can specifically bindhuman PCSK9 (eg, one, two or more rare variant forms disclosed herein)and is characterized by at least one of: (i) capable of reducing serumtotal cholesterol at least about 25-35% and sustaining the reductionover at least a 24 day period relative to a predose level; (ii) capableof reducing serum LDL cholesterol at least about 65-80% and sustainingthe reduction over at least a 24 day period relative to a predose level;(iii) capable of reducing serum LDL cholesterol at least about 40-70%and sustaining the reduction over at least a 60 or 90 day periodrelative to a predose level; (iv) capable of reducing serum triglycerideat least about 25-40% relative to predose level; (v) does not reduceserum HDL cholesterol or reduces serum HDL cholesterol no more than 5%relative to predose level. In some embodiments, an isolated nucleic acidmolecule is provided and it encodes the ligand. In some embodiments anexpression vector is provided and comprises the nucleic acid molecule.In some embodiments, a pharmaceutical composition is provided and it cancomprise the ligand and a pharmaceutically acceptable carrier. In someembodiments, a method is provided for treating a disease or conditionwhich is ameliorated, improved, inhibited or prevented with a PCSK9antagonist ligand of the invention. The method can compriseadministering a therapeutic amount of the pharmaceutical composition orligand to a subject in need thereof. In some embodiments, the subject isa human subject suffering from hypercholesterolemia, hyperlipidemia,indicated for LDL apheresis, identified as heterozygous for FamilialHypercholesterolemia, statin intolerant. statin uncontrolled, at riskfor developing hypercholesterolemia, dyslipidemia, cholestatic liverdisease, nephrotic syndrome, hypothyroidism, obesity, atherosclerosisand cardiovascular diseases. In some embodiments, a method of providinga treatment or therapy is provided to a subject. In some embodiments,the method comprises reducing serum cholesterol at least about 40-70%over at least 60 to 90 days. In some embodiments, a method of receivingtreatment or therapy is provided, the method can comprise receiving aligand thereof at a frequency of once every 60 to 90 days.

In one aspect, the invention provides a ligand of the invention which isor comprises an human antibody or antigen-binding fragment of a humanantibody that specifically binds and inhibits human proproteinconvertase subtilisin/kexin type 9 (hPCSK9, eg, one, two or more rarevariant forms disclosed herein and optionally form a and/or form a′),characterized by the ability to reduce serum LDL cholesterol in a humanby 40-80% over a 24, 60 or 90 day period relative to predose levels,with little or no reduction in serum HDL cholesterol and/or with littleor no measurable effect on liver function, as determined by ALT and ASTmeasurements.

In one embodiment, the ligand of the invention comprises an antibody orantigen-binding fragment of an antibody that specifically binds hPCSK9and is characterized by at least one of:

(i) capable of reducing serum total cholesterol at least about 25-35%and sustaining the reduction over at least a 24 day period relative to apredose level, preferably the reduction in serum total cholesterol is atleast about 30-40%;

(ii) capable of reducing serum LDL cholesterol at least about 65-80% andsustaining the reduction over at least a 24 day period relative to apredose level;

(iii) capable of reducing serum triglyceride at least about 25-40%relative to predose level;

(iv) does not reduce serum HDL cholesterol or reduces serum HDLcholesterol no more than 5% relative to predose level.

See US2011/0065902 for definitions of these terms and optional features,the disclosure of which is incorporated herein by reference in itsentirety.

In one embodiment, the invention comprises an antibody orantigen-binding fragment of an antibody that specifically binds hPCSK9and is characterized by at least one of:

(i) capable of reducing serum LDL cholesterol at least about 40-70% andsustaining the reduction over at least a 60 or 90 day period relative toa predose level;

(ii) capable of reducing serum triglyceride at least about 25-40%relative to predose level;

(iii) does not reduce serum HDL cholesterol or reduces serum HDLcholesterol no more than 5% relative to predose level.

In one embodiment, the antibody or antigen-binding fragment ischaracterized as exhibiting an enhanced binding affinity (KD) for hPCSK9at pH 5.5 relative to the KD at pH 7.4, as measured by plasmon surfaceresonance. In a specific embodiment, the antibody or fragment thereofexhibits at least a 20-fold, at least a 40-fold or at least a 50-foldenhanced affinity for PCSK9 at an acidic pH relative to a neutral pH, asmeasured by surface plasmon resonance.

In one embodiment, the antibody or antigen-binding fragment ischaracterized as not exhibiting an enhanced binding affinity for PCSK9at an acidic pH relative to a neutral pH, as measured by surface plasmonresonance. In a specific embodiment, the antibody or fragment thereofexhibits a decreased binding affinity at an acidic pH.

In another embodiment, the antibody or antigen-binding fragment bindshuman, human GOF mutation D374Y, cynomolgus monkey, rhesus monkey,mouse, rat and hamster PCSK9.

In one embodiment, the antibody or antigen-binding fragment binds humanand monkey PCSK9, but does not bind mouse, rat or hamster PCSK9.

In one embodiment, the invention comprises an antibody orantigen-binding fragment of an antibody comprising one or more of aheavy chain variable region (HCVR), light chain variable region (LCVR),HCDR1, HCDR2, HCDR3 disclosed in any of paragraphs [023]-[037] ofUS2011/0065902, the disclosures of which are incorporated herein byreference.

In a related embodiment, the invention comprises an antibody orantigen-binding fragment of an antibody which specifically binds hPCSK9,wherein the antibody or fragment comprises heavy and light chain CDRdomains contained within heavy and light chain sequence pairs selectedfrom the group consisting of SEQ ID NO (using the sequence numbering inUS2011/0065902): 2/10, 18/20, 22/24, 26/34, 42/44, 46/48, 50/58, 66/68,70/72, 74/82, 90/92, 94/96, 98/106, 114/116, 118/120, 122/130, 138/140,142/144, 146/154, 162/164, 166/168, 170/178, 186/188, 190/192, 194/202,210/212, 214/216, 218/226, 234/236, 238/240, 242/250, 258/260, 262/264,266/274, 282/284, 286/288, 290/298, 306/308, 310/312, 314/322, 330/332,334/336, 338/346, 354/356, 358/360, 362/370, 378/380, 382/384, 386/394,402/404, 406/408, 410/418, 426/428, 430/432, 434/442, 450/452, 454/456,458/466, 474/476, 478/480, 482/490, 498/500, 502/504, 506/514, 522/524,526/528, 530/538, 546/548, 550/552, 554/562, 570/572, 574/576, 578/586,594/596, 598/600, 602/610, 618/620, 622/624, 626/634, 642/644, 646/648,650/658, 666/668, 670/672, 674/682, 690/692, 694/696, 698/706, 714/716,718/720, 722/730, 738/740 and 742/744. In one embodiment, the CDRsequences are contained within HCVR and LCVR selected from the aminoacid sequence pairs of SEQ ID NO: 50/58, 66/68, 70/72, 74/82, 90/92,94/96, 122/130, 138/140, 142/144, 218/226, 234/236, 238/240, 242/250,258/260, 262/264, 314/322, 330/332 and 334/336. In more specificembodiments, the CDR sequences are comprised within HCVR/LCVR sequencesselected from SEQ ID NO: 90/92 or 218/226.

In an example, the invention features a pharmaceutical compositioncomprising a ligand of the invention, wherein the ligand comprises orconsists of a recombinant human antibody or fragment thereof whichspecifically binds hPCSK9 and a pharmaceutically acceptable carrier. Inone embodiment, the invention features a composition which is acombination of a ligand of the invention (eg, an antibody orantigen-binding fragment of an antibody), and a second therapeuticagent. The second therapeutic agent may be any agent that isadvantageously combined with the ligand of the invention, for example,an agent capable of inducing a cellular depletion of cholesterolsynthesis by inhibiting 3-hydroxy-3-methylglutaryl (HMG)-coenzyme A(CoA) reductase, such as, for example, cerovastatin, atorvastatin,simvastatin, pitavastin, rosuvastatin, fluvastatin, lovastatin,pravastatin, etc; capable of inhibiting cholesterol uptake and or bileacid re-absorption; capable of increasing lipoprotein catabolism (suchas niacin); and/or activators of the LXR transcription factor that playsa role in cholesterol elimination such as 22-hydroxycholesterol.

In an example, the invention provides a method for inhibiting hPCSK9activity using the anti-PCSK9 ligand of the invention (eg, an antibodyor antigen-binding portion of the antibody of the invention), whereinthe therapeutic methods comprise administering a therapeuticallyeffective amount of a pharmaceutical composition comprising an antibodyor antigen-binding fragment of an antibody of the invention. Thedisorder treated is any disease or condition which is improved,ameliorated, inhibited or prevented by removal, inhibition or reductionof PCSK9 activity. Specific populations treatable by the therapeuticmethods of the invention include subjects indicated for LDL apheresis,subjects with PCSK9-activating mutations (gain of function mutations,“GOF”), subjects with heterozygous Familial Hypercholesterolemia (heFH);subjects with primary hypercholesterolemia who are statin intolerant orstatin uncontrolled; and subjects at risk for developinghypercholesterolemia who may be preventably treated. Other indicationsinclude dyslipidemia associated with secondary causes such as Type 2diabetes mellitus, cholestatic liver diseases (primary biliarycirrhosis), nephrotic syndrome, hypothyroidism, obesity; and theprevention and treatment of atherosclerosis and cardiovascular diseases.

In specific embodiments of the method of the invention, the ligand ofthe invention (eg, anti-hPCSK9 antibody or antibody fragment of theinvention) is useful to reduce elevated total cholesterol, non-HDLcholesterol, LDL cholesterol, and/or apolipoprotein B (apolipoproteinB100).

The ligand (eg, antibody or antigen-binding fragment) of the inventionmay be used alone or in combination with a second agent, for example, anHMG-CoA reductase inhibitor and/or another lipid lowering drug.

Treatment Population

The invention provides therapeutic methods for treating a human patientin need of a composition or ligand of the invention. While modificationsin lifestyle and conventional drug treatment are often successful inreducing cholesterol levels, not all patients are able to achieve therecommended target cholesterol levels with such approaches. Variousconditions, such as familial hypercholesterolemia (FH), appear to beresistant to lowering of LDL-C levels in spite of aggressive use ofconventional therapy. Homozygous and heterozygous familialhypercholesterolemia (hoFH, heFH) is a condition associated withpremature atherosclerotic vascular disease. However, patients diagnosedwith hoFH are largely unresponsive to conventional drug therapy and havelimited treatment options. Specifically, treatment with statins, whichreduce LDL-C by inhibiting cholesterol synthesis and upregulating thehepatic LDL receptor, may have little effect in patients whose LDLreceptors are non-existent or defective. A mean LDL-C reduction of onlyless than about 20% has been recently reported in patients withgenotype-confirmed hoFH treated with the maximal dose of statins. Theaddition of ezetimibe 10 mg/day to this regimen resulted in a totalreduction of LDL-C levels of 27%, which is still far from optimal.Likewise, many patients are statin non-responsive, poorly controlledwith statin therapy, or cannot tolerate statin therapy; in general,these patients are unable to achieve cholesterol control withalternative treatments. There is a large unmet medical need for newtreatments that can address the short-comings of current treatmentoptions.

Specific populations treatable by the therapeutic methods of theinvention include patients indicated for LDL apheresis, subjects withPCSK9-activating (GOF) mutations, heterozygous FamilialHypercholesterolemia (heFH); subjects with primary hypercholesterolemiawho are statin intolerant or statin uncontrolled; and subjects at riskfor developing hypercholesterolemia who may be preventably treated.

Therapeutic Administration and Formulations

The invention provides therapeutic compositions comprising theanti-PCSK9 ligands, antibodies or antigen-binding fragments thereof ofthe present invention. The administration of therapeutic compositions inaccordance with the invention will be administered with suitablecarriers, excipients, and other agents that are incorporated intoformulations to provide improved transfer, delivery, tolerance, and thelike. A multitude of appropriate formulations can be found in theformulary known to all pharmaceutical chemists: Remington'sPharmaceutical Sciences, Mack Publishing Company, Easton, Pa. Theseformulations include, for example, powders, pastes, ointments, jellies,waxes, oils, lipids, lipid (cationic or anionic) containing vesicles(such as LIPOFECTINT™), DNA conjugates, anhydrous absorption pastes,oil-in-water and water-in-oil emulsions, emulsions carbowax(polyethylene glycols of various molecular weights), semi-solid gels,and semi-solid mixtures containing carbowax. See also Powell et al.“Compendium of excipients for parenteral formulations” PDA (1998) JPharm Sci Technol 52:238-311.

The dose may vary depending upon the age and the size of a subject to beadministered, target disease, conditions, route of administration, andthe like. When the ligand, eg, antibody, of the present invention isused for treating various conditions and diseases associated with PCSK9,including hypercholesterolemia, disorders associated with LDL andapolipoprotein B, and lipid metabolism disorders, and the like, in anadult patient, it is advantageous to intravenously administer the ligandor antibody of the present invention normally at a single dose of about0.01 to about 20 mg/kg body weight, more preferably about 0.02 to about7, about 0.03 to about 5, or about 0.05 to about 3 mg/kg body weight.Depending on the severity of the condition, the frequency and theduration of the treatment can be adjusted.

Various delivery systems are known and can be used to administer thepharmaceutical composition of the invention, thus the compositioninvention provides the ligand by e.g., encapsulation in liposomes,microparticles, microcapsules, recombinant cells capable of expressingthe mutant viruses, receptor mediated endocytosis (see, e.g., Wu et al.(1987) J. Biol. Chem. 262:4429-4432). Methods of introduction include,but are not limited to, intradermal, intramuscular, intraperitoneal,intravenous, subcutaneous, intranasal, epidural, and oral routes. Thecomposition may be administered by any convenient route, for example byinfusion or bolus injection, by absorption through epithelial ormucocutaneous linings (e.g., oral mucosa, rectal and intestinal mucosa,etc.) and may be administered together with other biologically activeagents. Administration can be systemic or local.

The pharmaceutical composition can be also delivered in a vesicle, inparticular a liposome (see Langer (1990) Science 249:1527-1533; Treat etal. (1989) in Liposomes in the Therapy of Infectious Disease and Cancer,Lopez Berestein and Fidler (eds.), Liss, New York, pp. 353-365;Lopez-Berestein, ibid., pp. 317-327; see generally ibid.).

In certain situations, the pharmaceutical composition can be deliveredin a controlled release system. In one embodiment, a pump may be used(see Langer, supra; Sefton (1987) CRC Crit. Ref. Biomed. Eng. 14:201).In another embodiment, polymeric materials can be used; see, MedicalApplications of Controlled Release, Langer and Wise (eds.), CRC Pres.,Boca Raton, Fla. (1974). In yet another embodiment, a controlled releasesystem can be placed in proximity of the composition's target, thusrequiring only a fraction of the systemic dose (see, e.g., Goodson, inMedical Applications of Controlled Release, supra, vol. 2, pp. 115-138,1984).

The injectable preparations may include dosage forms for intravenous,subcutaneous, intracutaneous and intramuscular injections, dripinfusions, etc. These injectable preparations may be prepared by methodspublicly known. For example, the injectable preparations may beprepared, e.g., by dissolving, suspending or emulsifying the antibody orits salt described above in a sterile aqueous medium or an oily mediumconventionally used for injections. As the aqueous medium forinjections, there are, for example, physiological saline, an isotonicsolution containing glucose and other auxiliary agents, etc., which maybe used in combination with an appropriate solubilizing agent such as analcohol (e.g., ethanol), a polyalcohol (e.g., propylene glycol,polyethylene glycol), a nonionic surfactant [e.g., polysorbate 80,HCO-50 (polyoxyethylene (50 mol) adduct of hydrogenated castor oil)],etc. As the oily medium, there are employed, e.g., sesame oil, soybeanoil, etc., which may be used in combination with a solubilizing agentsuch as benzyl benzoate, benzyl alcohol, etc. The injection thusprepared is preferably filled in an appropriate ampoule. Apharmaceutical composition of the present invention can be deliveredsubcutaneously or intravenously with a standard needle and syringe. Inaddition, with respect to subcutaneous delivery, a pen delivery devicereadily has applications in delivering a pharmaceutical composition ofthe present invention. Such a pen delivery device can be reusable ordisposable. A reusable pen delivery device generally utilizes areplaceable cartridge that contains a pharmaceutical composition. Onceall of the pharmaceutical composition within the cartridge has beenadministered and the cartridge is empty, the empty cartridge can readilybe discarded and replaced with a new cartridge that contains thepharmaceutical composition. The pen delivery device can then be reused.In a disposable pen delivery device, there is no replaceable cartridge.Rather, the disposable pen delivery device comes prefilled with thepharmaceutical composition held in a reservoir within the device. Oncethe reservoir is emptied of the pharmaceutical composition, the entiredevice is discarded.

Numerous reusable pen and autoinjector delivery devices haveapplications in the subcutaneous delivery of a pharmaceuticalcomposition of the present invention. Examples include, but certainlyare not limited to AUTOPEN™ (Owen Mumford, Inc., Woodstock, UK),DISETRONIC™ pen (Disetronic Medical Systems, Burghdorf, Switzerland),HUMALOG MIX 75/25™ pen, HUMALOG™ pen, HUMALIN 70/30™ pen (Eli Lilly andCo., Indianapolis, Ind.), NOVOPEN™I, II and III (Novo Nordisk,Copenhagen, Denmark), NOVOPEN JUNIOR™ (Novo Nordisk, Copenhagen,Denmark), BD™ pen (Becton Dickinson, Franklin Lakes, N.J.), OPTIPENT™,OPTIPEN PRO™, OPTIPEN STARLET™, and OPTICLIKT™ (sanofi-aventis,Frankfurt, Germany), to name only a few. Examples of disposable pendelivery devices having applications in subcutaneous delivery of apharmaceutical composition of the present invention include, butcertainly are not limited to the SOLOSTAR™ pen (sanofi-aventis), theFLEXPEN™ (Novo Nordisk), and the KWIKPEN™ (Eli Lilly).

Advantageously, the pharmaceutical compositions for oral or parenteraluse described above are prepared into dosage forms in a unit dose suitedto fit a dose of the active ingredients. Such dosage forms in a unitdose include, for example, tablets, pills, capsules, injections(ampoules), suppositories, etc. The amount of the aforesaid antibodycontained is generally about 5 to about 500 mg per dosage form in a unitdose; especially in the form of injection, it is preferred that theaforesaid antibody is contained in about 5 to about 100 mg and in about10 to about 250 mg for the other dosage forms.

The invention provides therapeutic methods in which the ligand, eg,antibody or antibody fragment, of the invention is useful to treathypercholesterolemia associated with a variety of conditions involvinghPCSK9. The anti-PCSK9 ligands, eg, antibodies or antibody fragments, ofthe invention are particularly useful for the treatment ofhypercholesterolemia and the like. Combination therapies may include theanti-PCSK9 ligand of the invention with, for example, one or more of anyagent that (1) induces a cellular depletion of cholesterol synthesis byinhibiting 3-hydroxy-3-methylglutaryl (HMG)-coenzyme A (CoA) reductase,such as cerivastatin, atorvastatin, simvastatin, pitavastatin,rosuvastatin, fluvastatin, lovastatin, pravastatin; (2) inhibitscholesterol uptake and or bile acid re-absorption; (3) increaselipoprotein catabolism (such as niacin); and activators of the LXRtranscription factor that plays a role in cholesterol elimination suchas 22-hydroxycholesterol or fixed combinations such as ezetimibe plussimvastatin; a statin with a bile resin (e.g., cholestyramine,colestipol, colesevelam), a fixed combination of niacin plus a statin(e.g., niacin with lovastatin); or with other lipid lowering agents suchas omega-3-fatty acid ethyl esters (for example, omacor).

Tailoring Antibodies to Rare PCSK9 Variant Profile

As outline above, the invention includes the possibility to tailortreatment of humans further by selecting antibody-based ligands withvariable domains based on gene segments commonly found in humans of theethnic populations where the variant PCSK9 forms are found to meet theselection criteria of the invention. An example is provided below forligands comprising antibody VH domains derived from recombination ofhuman VH3-23.

The inventor analysed the frequencies and distribution of various humanVH3-23 alleles and realised the desirability of using ligands based onhuman VH3-23 alleles comprising SNP rs56069819. This SNP corresponds toa change from leucine at position 24 in the encoded protein sequence toa valine at that position (L24V change) and the SNP is at coordinate106268889 on human chromosome 14.

FIG. 2 shows the cumulative allele frequency distribution across the1000 Genomes Project database of human VH3-23 alleles comprising SNPrs56069819 (such alleles denonted “C” and the most frequent allele(which does not comprise this SNP) denoted “A”). The figure shows thatVH3-23 alleles comprising SNP rs56069819 are present at a cumulativefrequency of 11% across all human ethnic populations taken as a whole,whereas in certain specific human ethnic sub-populations (ASW, LWK, YRI,CEU and GBR) such alleles are present at an above-average cumulativefrequency. Indicated in the figure are those human PCSK9 variant forms(marked “Variants”) that are found in the various sub-populations withabove-average occurrence of human VH3-23 alleles comprising SNPrs56069819. Table 7 shows the VH3-23 variants and the SNPs that theycomprise, as well as their cumulative allele frequencies as found in the1000 Genomes Project database.

Notably, human VH3-23 alleles comprising SNP rs56069819 were found inthe CEU population at a frequency that is almost double the frequency of11% for all populations. For the ASW and YRI populations the frequencywas over a quarter of the population. Thus, the invention advantageouslyenables one to select a ligand comprising an antibody or antibodyfragment, wherein the antibody or fragment comprises a VH domain derivedfrom the recombination of a human VH gene segment, a human D genesegment and a human JH gene segment, the VH gene segment comprising anucleotide sequence that comprises SNP rs56069819 (dbSNP numbering,build number as recited above).

In an example, one can tailor the treatment further by selecting such aligand that specifically binds to a human PCSK9 selected from forms: fc, m, e, h, p, q and aj, such forms being those appearing in humanpopulations ASW, LWK, YRI, CEU and GBR.

In an example, the ligand specifically binds to a human PCSK9 comprisinga mutation I474V in SEQ ID NO: 1, wherein the human is of ASW, LWK, YRI,CEU or GBR ancestry. Optionally, the human comprises gene segmentVH3-23*04 and/or a nucleotide sequence encoding said PCSK9 comprising amutation I474V in SEQ ID NO: 1. In an example, additionally the ligandis an antibody or fragment comprising a VH domain derived from therecombination of human gene segment VH3-23*04.

In an example, the ligand specifically binds to a human PCSK9 comprisinga mutation I474V in SEQ ID NO: 1 (eg, form f, r, p, e or aj), whereinthe human is of ASW, LWK, YRI, CEU or GBR ancestry. Optionally, thehuman comprises gene segment VH3-23*04 and/or a nucleotide sequenceencoding said PCSK9 comprising a mutation I474V in SEQ ID NO: 1. In anexample, additionally the ligand is an antibody or fragment comprising aVH domain derived from the recombination of human gene segmentVH3-23*04. Optionally, the ligand is for treating or preventingdislipidemia in said human, eg, for reducing cholesterol or maintaininga previously reduced cholesterol level in said human.

In an example, the ligand specifically binds to a human PCSK9 comprisinga mutation E670G in SEQ ID NO: 1 (eg, form c, r or q), wherein the humanis of ASW, LWK, YRI, CEU or GBR ancestry. Optionally, the humancomprises gene segment VH3-23*04 and/or a nucleotide sequence encodingsaid PCSK9 comprising a mutation I474V in SEQ ID NO: 1. In an example,additionally the ligand is an antibody or fragment comprising a VHdomain derived from the recombination of human gene segment VH3-23*04.Optionally, the ligand is for treating or preventing dislipidemia insaid human, eg, for reducing cholesterol or maintaining a previouslyreduced cholesterol level in said human.

In an example, the ligand specifically binds to a human PCSK9 comprisinga mutation Q619P in SEQ ID NO: 1 (eg, form h), wherein the human is ofASW, LWK, YRI, CEU or GBR ancestry. Optionally, the human comprises genesegment VH3-23*04 and/or a nucleotide sequence encoding said PCSK9comprising a mutation I474V in SEQ ID NO: 1. In an example, additionallythe ligand is an antibody or fragment comprising a VH domain derivedfrom the recombination of human gene segment VH3-23*04. Optionally, theligand is for treating or preventing dislipidemia in said human, eg, forreducing cholesterol or maintaining a previously reduced cholesterollevel in said human.

In an example, the ligand specifically binds to a human PCSK9 comprisinga mutation N425S in SEQ ID NO: 1 (eg, form e), wherein the human is ofASW, LWK, YRI, CEU or GBR ancestry. Optionally, the human comprises genesegment VH3-23*04 and/or a nucleotide sequence encoding said PCSK9comprising a mutation I474V in SEQ ID NO: 1. In an example, additionallythe ligand is an antibody or fragment comprising a VH domain derivedfrom the recombination of human gene segment VH3-23*04. Optionally, theligand is for treating or preventing dislipidemia in said human, eg, forreducing cholesterol or maintaining a previously reduced cholesterollevel in said human.

In an example, the ligand specifically binds to a human PCSK9 comprisinga mutation R46L in SEQ ID NO: 1 (eg, form aj), wherein the human is ofASW, LWK, YRI, CEU or GBR ancestry. Optionally, the human comprises genesegment VH3-23*04 and/or a nucleotide sequence encoding said PCSK9comprising a mutation I474V in SEQ ID NO: 1. In an example, additionallythe ligand is an antibody or fragment comprising a VH domain derivedfrom the recombination of human gene segment VH3-23*04. Optionally, theligand is for treating or preventing dislipidemia in said human, eg, forincreasing cholesterol level in said human.

In an example, the ligand specifically binds to a human PCSK9 comprisinga mutation A53V in SEQ ID NO: 1 (eg, form p or q), wherein the human isof ASW, LWK, YRI, CEU or GBR ancestry. Optionally, the human comprisesgene segment VH3-23*04 and/or a nucleotide sequence encoding said PCSK9comprising a mutation I474V in SEQ ID NO: 1. In an example, additionallythe ligand is an antibody or fragment comprising a VH domain derivedfrom the recombination of human gene segment VH3-23*04. Optionally, theligand is for treating or preventing dislipidemia in said human, eg, forincreasing cholesterol level in said human.

In an example, the ligand specifically binds to a human PCSK9 comprisinga mutation A443T in SEQ ID NO: 1 (eg, form m or h), wherein the human isof ASW, LWK, YRI, CEU or GBR ancestry. Optionally, the human comprisesgene segment VH3-23*04 and/or a nucleotide sequence encoding said PCSK9comprising a mutation I474V in SEQ ID NO: 1. In an example, additionallythe ligand is an antibody or fragment comprising a VH domain derivedfrom the recombination of human gene segment VH3-23*04. Optionally, theligand is for treating or preventing dislipidemia in said human, eg, forincreasing cholesterol level in said human.

In an example, the VH gene segment is VH3-23*04, which is a commonlyfound variant that comprises SNP rs56069819 in human populations ASW,LWK, YRI, CEU and GBR.

In an example, the ligand is for treating and/or preventing aPCSK9-mediated disease or condition in a human that expresses a humanPCSK9 selected from forms: f c, m, e, h, p, q and aj.

In an example, the ligand is for treating and/or preventing aPCSK9-mediated disease or condition in a human of ASW, LWK, YRI, CEU orGBR ancestry.

In an embodiment, the ligand is for treating and/or preventing aPCSK9-mediated disease or condition in a human of ASW ancestry, whereinthe human expresses a PCSK9 selected from f c, m, e, h, p and q or thehuman comprises a corresponding nucleotide or amino acid sequence as setout in Table 6. Optionally this ligand comprises a VH domain derivedfrom recombination of human VH3-23*04.

In an embodiment, the ligand is for treating and/or preventing aPCSK9-mediated disease or condition in a human of LWK ancestry, whereinthe human expresses a PCSK9 selected from f c, m, e and h or the humancomprises a corresponding nucleotide or amino acid sequence as set outin Table 6. Optionally this ligand comprises a VH domain derived fromrecombination of human VH3-23*04.

In an embodiment, the ligand is for treating and/or preventing aPCSK9-mediated disease or condition in a human of YRI ancestry, whereinthe human expresses a PCSK9 selected from f c, m, e and h or the humancomprises a corresponding nucleotide or amino acid sequence as set outin Table 6. Optionally this ligand comprises a VH domain derived fromrecombination of human VH3-23*04.

In an embodiment, the ligand is for treating and/or preventing aPCSK9-mediated disease or condition in a human of CEU ancestry, whereinthe human expresses a PCSK9 selected from f, c, p and aj or the humancomprises a corresponding nucleotide or amino acid sequence as set outin Table 6. Optionally this ligand comprises a VH domain derived fromrecombination of human VH3-23*04.

In an embodiment, the ligand is for treating and/or preventing aPCSK9-mediated disease or condition in a human of GBR ancestry, whereinthe human expresses a PCSK9 selected from f, c and p or the humancomprises a corresponding nucleotide or amino acid sequence as set outin Table 6. Optionally this ligand comprises a VH domain derived fromrecombination of human VH3-23*04.

In an example, the ligand is alirocumab.

In other embodiments of any configuration or TOI herein, as explainedmore fully above, the invention provides for ligands which are tailoredto the human recipient's genotype and/or phenotype based on alternativehuman VH gene segments, or on Vκ, Vλ or constant region gene segments(see further Table 9 for representative variants).

For example, the ligand of the invention comprises or consists of anantibody that comprises a VH domain that is derived from therecombination of a human VH gene segment, a human D gene segment and ahuman JH gene segment, wherein the VH gene segment is selected from thegroup consisting of (i) IGHV1-18*01 and the genome of the humancomprises a human IGHV1-18*01 nucleotide sequence or the human expressesantibodies comprising variable domains derived from the recombination ofhuman IGHV1-18*01; or (ii) IGVH1-46*01 and the genome of the humancomprises a human IGHV1-46*01 nucleotide sequence or the human expressesantibodies comprising variable domains derived from the recombination ofhuman IGHV1-46*01.

For example, the ligand of the invention comprises or consists of anantibody that comprises a VL domain that is derived from therecombination of a human VL gene segment and a human JL gene segment,wherein the VL gene segment is selected from the group consisting of (i)IGKV4-1*01 and the genome of the human comprises a human IGKV4-1*01nucleotide sequence or the human expresses antibodies comprisingvariable domains derived from the recombination of human IGKV4-1*01;(ii) IGLV2-14*01 and the genome of the human comprises a humanIGLV2-14*01 nucleotide sequence or the human expresses antibodiescomprising variable domains derived from the recombination of humanIGLV2-14*01; or (iii) IGKV1-13*02 and the genome of the human comprisesa human IGKV1-13*02 nucleotide sequence or the human expressesantibodies comprising variable domains derived from the recombination ofhuman IGKV1-13*02.

For example, the inventor identified the possibility of addressing therarer IGH-gamma-1 SNPs 204D (observed cumulative frequency of 0.296) and206L (observed cumulative frequency of 0.283) individually or incombination. These residues are part of the CH3 domain, and as such theyform part of antibody Fc regions. Thus, matching of these CH3 variationswith the patient is especially beneficial for reasons as discussedabove. Thus, in this example the ligand of the invention comprises orconsists of an antibody that comprises a human gamma-1 heavy chainconstant region that comprises an Asp corresponding to position 204 ofSEQ ID NO: 42 or a Leu corresponding to position 206 of SEQ ID NO: 42and wherein the genome of the human comprises a gamma-1 heavy chainconstant region nucleotide sequence that encodes such an Asp or Leu orthe human expresses antibodies comprising human gamma-1 constant regionscomprising such an Asp or Leu. An example of such a ligand isalirocumab.

In another example, the inventor identified the possibility ofaddressing IGH-gamma-2 SNPs. This included consideration of Fc regionvariation—in this respect, the inventor focused on positions 161 and 257which are in the Fc region. Thus, in this example the ligand of theinvention comprises or consists of an antibody that comprises a humangamma-2 heavy chain constant region that comprises an amino acidselected from the group consisting of a Pro corresponding to position 72of SEQ ID NO: 44, an Asn corresponding to position 75 of SEQ ID NO: 44,a Phe corresponding to position 76 of SEQ ID NO: 44, a Val correspondingto position 161 of SEQ ID NO: 44 and an Ala corresponding to position257 of SEQ ID NO: 44; and wherein the genome of the human comprises agamma-2 heavy chain constant region nucleotide sequence that encodessuch a selected amino acid or the human expresses antibodies comprisinghuman gamma-2 constant regions comprising such a selected amino acid. Anexample of such a ligand is evolocumab or bococizumab.

In another example, the inventor addressed human kappa constant regionvariation. Thus, in this example the ligand of the invention comprisesor consists of an antibody that comprises a human kappa light chainconstant region that comprises a Val corresponding to position 84 of SEQID NO: 50 or a Cys corresponding to position 87 of SEQ ID NO: 50; andwherein the genome of the human comprises a kappa light chain constantregion nucleotide sequence that encodes such a Val or Cys or the humanexpresses antibodies comprising human kappa light chain constant regionscomprising such a Val or Cys. An example of such a ligand is alirocumabor bococizumab.

In another example, the inventor addressed human lambda constant regionvariation. Thus, in this example the ligand of the invention comprisesor consists of an antibody that comprises a human IGLC2*01 light chainconstant region; and wherein the genome of the human comprises a humanIGLC2*01 nucleotide sequence or the human expresses antibodiescomprising human light chain IGLC2*01 constant regions. An example ofsuch a ligand is evolocumab.

Further exemplary ligands are in the paragraphs 1-17 as follows.

-   -   1. An antibody or antibody fragment for use in a method of (a)        reducing cholesterol level or maintaining previously reduced        cholesterol level in a human in need thereof, or (b) targeting        PCSK9 in a human,        -   wherein the antibody or fragment comprises a human gamma            heavy chain constant region that comprises a first amino            acid that is encoded by a human gamma heavy chain constant            region gene segment SNP, and the antibody or fragment            specifically binds a proprotein convertase subtilisin/kexin            type 9 (PCSK9) amino acid sequence that comprises a            C-terminal domain comprising a mutation selected from the            group consisting of I474V, Q619P, N425S and E670G (eg,            selected from I474V and E670G) in SEQ ID NO:1, wherein the            human comprises a nucleotide sequence encoding said PCSK9            amino acid sequence and comprises a human gamma heavy chain            constant region gene segment comprising said SNP, or the            human expresses antibodies comprising human gamma constant            regions comprising said first amino acid.        -   In an embodiment of (b), the antibody or fragment treats or            reduces cholesterol level or maintains previously reduced            cholesterol level in the human.        -   In an alternative, paragraph 1 provides:—        -   An antibody or antibody fragment for use in a method of (a)            reducing cholesterol level or maintaining previously reduced            cholesterol level in a human in need thereof, or (b)            targeting PCSK9 in a human,        -   wherein the antibody or fragment comprises a human gamma-1            heavy chain constant region that comprises an Asp            corresponding to position 204 of SEQ ID NO: 42 or a Leu            corresponding to position 206 of SEQ ID NO: 42, and the            antibody or fragment specifically binds a proprotein            convertase subtilisin/kexin type 9 (PCSK9) amino acid            sequence that comprises a C-terminal domain comprising a            said PCSK9 mutation (eg, I474V or E670G) in SEQ ID NO:1,            wherein the human comprises a nucleotide sequence encoding            said amino acid sequence and comprises an IGHG1*01 human            heavy chain constant region gene segment, or the human            expresses antibodies comprising human gamma-1 constant            regions comprising such an Asp and Leu.        -   In an embodiment, said mutation is I474V. In another            embodiment, said mutation is E670G.        -   In another embodiment, said mutation is N425S. In another            embodiment, said mutation is Q619P.        -   In an embodiment of (b), the antibody or fragment treats or            reduces cholesterol level or maintains previously reduced            cholesterol level in the human.        -   An example provides:—        -   An antibody or antibody fragment for use in a method of (a)            reducing cholesterol level or maintaining previously reduced            cholesterol level in a human in need thereof, or (b)            targeting PCSK9 in a human,        -   wherein the antibody or fragment comprises a human gamma-1            heavy chain constant region that comprises an Asp            corresponding to position 204 of SEQ ID NO: 42 and a Leu            corresponding to position 206 of SEQ ID NO: 42, and the            antibody or fragment specifically binds a proprotein            convertase subtilisin/kexin type 9 (PCSK9) amino acid            sequence that comprises a C-terminal domain comprising a            mutation I474V in SEQ ID NO:1, wherein the human comprises a            nucleotide sequence encoding said amino acid sequence and            comprises an IGHG1*01 human heavy chain constant region gene            segment. Optionally, the antibody or fragment comprises an            IGHG1*01 human heavy chain constant region.        -   In an embodiment of (b), the antibody or fragment treats or            reduces cholesterol level or maintains previously reduced            cholesterol level in the human.        -   Another example provides:—        -   An antibody or antibody fragment for use in a method of (a)            reducing cholesterol level or maintaining previously reduced            cholesterol level in a human in need thereof, or (b)            targeting PCSK9 in a human,        -   wherein the antibody or fragment comprises a human gamma-1            heavy chain constant region that comprises an Asp            corresponding to position 204 of SEQ ID NO: 42 and a Leu            corresponding to position 206 of SEQ ID NO: 42, and the            antibody or fragment specifically binds a proprotein            convertase subtilisin/kexin type 9 (PCSK9) amino acid            sequence that comprises a C-terminal domain comprising a            mutation E670G in SEQ ID NO:1, wherein the human comprises a            nucleotide sequence encoding said amino acid sequence and            comprises an IGHG1*01 human heavy chain constant region gene            segment. Optionally, the antibody or fragment comprises an            IGHG1*01 human heavy chain constant region.        -   In an embodiment of (b), the antibody or fragment treats or            reduces cholesterol level or maintains previously reduced            cholesterol level in the human.        -   In an example, said antibody or antibody fragment has been            determined to specifically bind a proprotein convertase            subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal            domain comprising a mutation selected from the group            consisting of I474V, Q619P, N425S and E670G (eg, selected            from I474V and E670G) in SEQ ID NO: 1, wherein the antibody            or fragment comprises a human gamma-1 heavy chain constant            region that comprises an Asp corresponding to position 204            of SEQ ID NO: 42 and a Leu corresponding to position 206 of            SEQ ID NO: 42 and wherein said human comprises (i) an            IGHG1*01 human heavy chain constant region gene segment            and (ii) a nucleotide sequence encoding said proprotein            convertase subtilisin/kexin type 9 (PCSK9) that comprises a            C-terminal domain comprising said mutation (eg, I474V or            E670G) in SEQ ID NO: 1.    -   2. The antibody or antibody fragment of paragraph 1, wherein the        antibody comprises a human gamma-1 heavy chain constant region        that comprises an Asp corresponding to position 204 of SEQ ID        NO: 42 and a Leu corresponding to position 206 of SEQ ID NO: 42.    -   3. The antibody or antibody fragment of paragraph 1 or 2,        wherein the antibody comprises an IGHG1*01 human heavy chain        constant region.    -   4. The antibody or antibody fragment of any one of paragraphs 1        to 3, wherein the human has been determined to comprise the        nucleotide sequence that encodes a PCSK9 comprising a C-terminal        domain comprising said mutation (eg, I474V or E670G) in SEQ ID        NO: 1 and/or a proprotein convertase subtilisin/kexin type 9        (PCSK9) variant protein encoded by the nucleotide sequence of        SEQ ID NO: 29 or 30.    -   5. The antibody or antibody fragment of any one of paragraphs 1        to 4, the method comprising the step of determining that the        human comprises the nucleotide sequence that encodes a PCSK9        comprising a C-terminal domain comprising said mutation (eg,        I474V or E670G) and/or a proprotein convertase subtilisin/kexin        type 9 (PCSK9) variant protein comprising said mutation (eg,        I474V or E670G), optionally, wherein the determining step is        performed before administration of the antibody to the human.    -   6. The antibody or antibody fragment of paragraph 5, wherein the        step of determining comprises assaying a biological sample from        the human for a nucleotide sequence encoding the PCSK9 that        comprises the C-terminal domain comprising the mutation (eg,        I474V or E670G) in SEQ ID NO: 1.    -   7. The antibody or antibody fragment of paragraph 6, wherein the        assaying comprises contacting the biological sample with        -   a. at least one oligonucleotide probe comprising a sequence            of at least 10 contiguous nucleotides that can specifically            hybridize to and identify in the biological sample a            nucleotide sequence encoding the PCSK9 that comprises the            C-terminal domain comprising the mutation (eg, I474V or            E670G) in SEQ ID NO: 1 or that specifically hybridizes to an            antisense of said sequence, wherein said nucleic acid            hybridizes to at least one nucleotide present in said            selected sequence which is not present in SEQ ID NO: 28 or            hybridizes to an antisense sequence thereby forming a            complex when at least one nucleotide sequence encoding the            PCSK9 that comprises the C-terminal domain comprising the            mutation (eg, I474V or E670G) in SEQ ID NO: 1 is present;            and/or        -   b. at least one oligonucleotide probe comprising a sequence            of at least 10 contiguous nucleotides of a nucleotide            sequence encoding the PCSK9 that comprises the C-terminal            domain comprising the mutation (eg, I474V or E670G) in SEQ            ID NO: 1 or comprising an antisense sequence of said            contiguous nucleotides, wherein said sequence of contiguous            nucleotides comprises at least one nucleotide present in            said selected sequence which is not present in SEQ ID NO: 28            thereby forming a complex when the nucleotide sequence            encoding the PCSK9 that comprises a C-terminal domain            comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1            is present; and detecting the presence or absence of the            complex, wherein detecting the presence of the complex            determines that the human comprises the PCSK9 that comprises            the C-terminal domain comprising the mutation (eg, I474V or            E670G) in SEQ ID NO: 1.    -   8. The antibody or antibody fragment of paragraph 6 or 7,        wherein the assaying comprises nucleic acid amplification and        optionally one or more methods selected from sequencing, next        generation sequencing, nucleic acid hybridization, and        allele-specific amplification and/or wherein the assaying is        performed in a multiplex format.    -   9. The antibody or antibody fragment of any one of paragraphs 1        to 8, wherein said antibody or antibody fragment is for        administration to a human that is or has been further determined        to be substantially resistant to statin treatment.    -   10. The antibody or antibody fragment of any one of paragraphs 1        to 9, wherein antibody or antibody fragment is for        administration to a human that is receiving or has received        statin treatment or has reduced responsiveness to statin        treatment.    -   11. The antibody or antibody fragment of paragraph 9 or 10,        wherein said antibody or antibody fragment is for administration        to the human separately or simultaneously with said statin        treatment.    -   12. The antibody or antibody fragment of any one of paragraphs 6        to 10, wherein said biological sample comprises serum, blood,        faeces, tissue, a cell, urine and/or saliva of said human.    -   13. The antibody or antibody fragment of any one of paragraphs 1        to 12, wherein said human is indicated as heterozygous for a        nucleotide sequence encoding the PCSK9 C-terminal domain        comprising a said PCSK9 mutation (eg, I474V or E670G),        optionally, wherein said human is further indicated as        comprising the nucleotide sequence of SEQ ID NO: 28, or said        human is indicated as homozygous for a nucleotide sequence        encoding the PCSK9 C-terminal domain comprising a said PCSK9        mutation (eg, I474V or E670G) in SEQ ID NO: 1.    -   14. The antibody or antibody fragment of any one of paragraphs 1        to 13, wherein said human has been diagnosed with at least one        condition selected from a lipid disorder, hyperlipoproteinemia,        hyperlipidemia, dyslipidemia, hypercholesterolemia, a heart        attack, a stroke, coronary heart disease, atherosclerosis,        peripheral vascular disease, claudication (eg, claudication        associated with elevated cholesterol) and high blood pressure.    -   15. The antibody or antibody fragment of any one of paragraphs 1        to 14, wherein said antibody or antibody fragment treats or        reduces the risk in said human of at least one condition        selected from a lipid disorder, hyperlipoproteinemia,        hyperlipidemia, dyslipidemia, hypercholesterolemia, a heart        attack, a stroke, coronary heart disease, atherosclerosis,        peripheral vascular disease, claudication (eg, claudication        associated with elevated cholesterol) and high blood pressure.    -   16. The antibody or antibody fragment of any one of paragraphs 1        to 15, wherein the nucleotide sequence is SEQ ID NO: 29 or 30.    -   17. The antibody or antibody fragment of any one of paragraphs 1        to 16, wherein said antibody or antibody fragment is for        administration by intravenous or subcutaneous administration        and/or is comprised in an injectable preparation.

Further exemplary methods are in the paragraphs 1-18 as follows.

-   1. A method of (a) reducing cholesterol level or maintaining    previously reduced cholesterol level in a human in need thereof    or (b) targeting PCSK9 in a human,    -   the method comprising administering to said human an antibody or        antibody fragment that specifically binds a proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising a said PCSK9 mutation (eg, I474V or        E670G) in SEQ ID NO: 1, wherein the antibody or fragment        comprises a human gamma-1 heavy chain constant region that        comprises an Asp corresponding to position 204 of SEQ ID NO: 42        or a Leu corresponding to position 206 of SEQ ID NO: 42 and        wherein said human comprises (i) an IGHG1*01 human heavy chain        constant region gene segment, or the human expresses antibodies        comprising human gamma-1 heavy chain constant regions comprising        such an Asp and Leu and (ii) a nucleotide sequence encoding said        proprotein convertase subtilisin/kexin type 9 (PCSK9) that        comprises a C-terminal domain comprising said mutation (eg,        I474V or E670G) in SEQ ID NO: 1.    -   In an embodiment, said mutation is I474V. In another embodiment,        said mutation is E670G.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   An example provides:—    -   A method of (a) reducing cholesterol level or maintaining        previously reduced cholesterol level in a human in need thereof        or (b) targeting PCSK9 in a human,    -   the method comprising administering to said human an antibody or        antibody fragment that specifically binds a proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising a mutation I474 in SEQ ID NO: 1,        wherein the antibody or fragment comprises a human gamma-1 heavy        chain constant region that comprises an Asp corresponding to        position 204 of SEQ ID NO: 42 and a Leu corresponding to        position 206 of SEQ ID NO: 42 and wherein said human        comprises (i) an IGHG1*01 human heavy chain constant region gene        segment and (ii) a nucleotide sequence encoding said proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising said mutation I474V in SEQ ID        NO: 1. Optionally, the antibody or fragment comprises a IGHG1*01        human heavy chain constant region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   Another example provides:—    -   A method of (a) reducing cholesterol level or maintaining        previously reduced cholesterol level in a human in need thereof        or (b) targeting PCSK9 in a human,    -   the method comprising administering to said human an antibody or        antibody fragment that specifically binds a proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising a mutation E670G in SEQ ID NO: 1,        wherein the antibody or fragment comprises a human gamma-1 heavy        chain constant region that comprises an Asp corresponding to        position 204 of SEQ ID NO: 42 and a Leu corresponding to        position 206 of SEQ ID NO: 42 and wherein said human        comprises (i) an IGHG1*01 human heavy chain constant region gene        segment and (ii) a nucleotide sequence encoding said proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising said mutation E670G in SEQ ID        NO: 1. Optionally, the antibody or fragment comprises an        IGHG1*01 human heavy chain constant region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   In an example, said antibody or antibody fragment has been        determined to specifically bind a proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising a said PCSK9 mutation (eg, I474V or E670G) in        SEQ ID NO: 1, wherein the antibody or fragment comprises a human        gamma-1 heavy chain constant region that comprises an Asp        corresponding to position 204 of SEQ ID NO: 42 and a Leu        corresponding to position 206 of SEQ ID NO: 42 and wherein said        human comprises (i) an IGHG1*01 human heavy chain constant        region gene segment and (ii) a nucleotide sequence encoding said        proprotein convertase subtilisin/kexin type 9 (PCSK9) that        comprises a C-terminal domain comprising said mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   2. The method of paragraph 1, comprising, before said administering,    selecting a human comprising said nucleotide sequence of (ii),    wherein the human is the human of paragraph 1.-   3. The method of paragraph 1 or 2, wherein the antibody comprises a    human gamma-1 heavy chain constant region that comprises an Asp    corresponding to position 204 of SEQ ID NO: 42 and a Leu    corresponding to position 206 of SEQ ID NO: 42.-   4. The method of paragraph 1, 2 or 3, wherein the antibody comprises    an IGHG1*01 human heavy chain constant region.-   5. The method of any one of paragraphs 1 to 4, wherein the human has    been determined to comprise the nucleotide sequence that encodes a    PCSK9 comprising a C-terminal domain comprising said mutation (eg,    I474V or E670G) in SEQ ID NO: 1 and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein encoded by the    nucleotide sequence of SEQ ID NO: 29 or 30.-   6. The method of any one of paragraphs 1 to 5, comprising the step    of determining that the human comprises the nucleotide sequence that    encodes a PCSK9 comprising a C-terminal domain comprising said    mutation (eg, I474V or E670G) and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein comprising said    mutation (eg, I474V or E670G), optionally, wherein the determining    step is performed before administration of the antibody to the    human.-   7. The method of paragraph 6, wherein the step of determining    comprises assaying a biological sample from the human for a    nucleotide sequence encoding the PCSK9 that comprises the C-terminal    domain comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1.-   8. The method of paragraph 7, wherein the assaying comprises    contacting the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and detecting the presence or        absence of the complex, wherein detecting the presence of the        complex determines that the human comprises the PCSK9 that        comprises the C-terminal domain comprising the mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   9. The method of paragraph 7 or 8, wherein the assaying comprises    nucleic acid amplification and optionally one or more methods    selected from sequencing, next generation sequencing, nucleic acid    hybridization, and allele-specific amplification and/or wherein the    assaying is performed in a multiplex format.-   10. The method of any one of paragraphs 1 to 9, wherein said human    is or has been further determined to be substantially resistant to    statin treatment.-   11. The method of any one of paragraphs 1 to 10, wherein said human    is receiving or has received statin treatment or has reduced    responsiveness to statin treatment.-   12. The method of paragraph 10 or 11, wherein said antibody or    antibody fragment is administered to the human separately or    simultaneously with said statin treatment.-   13. The method of any one of paragraphs 7 to 9, wherein said    biological sample comprises serum, blood, faeces, tissue, a cell,    urine and/or saliva of said human.-   14. The method of any one of paragraphs 1 to 13, wherein said human    is indicated as heterozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation (eg, I474V or    E670G), optionally, wherein said human is further indicated as    comprising the nucleotide sequence of SEQ ID NO: 28, or said human    is indicated as homozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation I474V or E670G in    SEQ ID NO: 1.-   15. The method of any one of paragraphs 1 to 14, wherein said human    has been diagnosed with at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   16. The method of any one of paragraphs 1 to 15, wherein said    antibody or antibody fragment treats or reduces the risk in said    human of at least one condition selected from a lipid disorder,    hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   17. The method of any one of paragraphs 1 to 16, wherein the    nucleotide sequence is SEQ ID NO: 29 or 30.-   18. The method of any one of paragraphs 1 to 17, wherein said    antibody or antibody fragment is administered by intravenous or    subcutaneous administration and/or is comprised in an injectable    preparation.

Further exemplary ligands are in the paragraphs 1-17 as follows.

-   1. An antibody or antibody fragment for use in a method of (a)    reducing cholesterol level or maintaining previously reduced    cholesterol level in a human in need thereof or (b) targeting PCSK9    in a human,    -   wherein the antibody comprises a human gamma-2 heavy chain        constant region that comprises an amino acid selected from the        group consisting of a Pro corresponding to position 72 of SEQ ID        NO: 44, an Asn corresponding to position 75 of SEQ ID NO: 44, a        Phe corresponding to position 76 of SEQ ID NO: 44, a Val        corresponding to position 161 of SEQ ID NO: 44 and an Ala        corresponding to position 257 of SEQ ID NO: 44, and the antibody        or fragment specifically binds a proprotein convertase        subtilisin/kexin type 9 (PCSK9) amino acid sequence that        comprises a C-terminal domain comprising a said PCSK9 mutation        (eg, I474V or E670G) in SEQ ID NO:1, wherein the human comprises        a nucleotide sequence encoding said amino acid sequence and        comprises an IGHG2*01 human heavy chain constant region gene        segment, or the human expresses antibodies comprising human        gamma-2 constant regions comprising such a Pro, Asn, Phe, Val        and Ala.    -   In an embodiment, said mutation is I474V. In another embodiment,        said mutation is E670G.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   An example provides:—    -   An antibody or antibody fragment for use in a method of (a)        reducing cholesterol level or maintaining previously reduced        cholesterol level in a human in need thereof or (b) targeting        PCSK9 in a human,    -   wherein the antibody comprises a human gamma-2 heavy chain        constant region that comprises a Pro corresponding to position        72 of SEQ ID NO: 44, an Asn corresponding to position 75 of SEQ        ID NO: 44, a Phe corresponding to position 76 of SEQ ID NO: 44,        a Val corresponding to position 161 of SEQ ID NO: 44 and an Ala        corresponding to position 257 of SEQ ID NO: 44, and the antibody        or fragment specifically binds a proprotein convertase        subtilisin/kexin type 9 (PCSK9) amino acid sequence that        comprises a C-terminal domain comprising a mutation I474V in SEQ        ID NO:1, wherein the human comprises a nucleotide sequence        encoding said amino acid sequence and comprises an IGHG2*01        human heavy chain constant region gene segment. Optionally, the        antibody or fragment comprises an IGHG2*01 human heavy chain        constant    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.region.    -   Another example provides:—    -   An antibody or antibody fragment for use in a method of (a)        reducing cholesterol level or maintaining previously reduced        cholesterol level in a human in need thereof or (b) targeting        PCSK9 in a human,    -   wherein the antibody comprises a human gamma-2 heavy chain        constant region that comprises a Pro corresponding to position        72 of SEQ ID NO: 44, an Asn corresponding to position 75 of SEQ        ID NO: 44, a Phe corresponding to position 76 of SEQ ID NO: 44,        a Val corresponding to position 161 of SEQ ID NO: 44 and an Ala        corresponding to position 257 of SEQ ID NO: 44, and the antibody        or fragment specifically binds a proprotein convertase        subtilisin/kexin type 9 (PCSK9) amino acid sequence that        comprises a C-terminal domain comprising a mutation E670G in SEQ        ID NO:1, wherein the human comprises a nucleotide sequence        encoding said amino acid sequence and comprises an IGHG2*01        human heavy chain constant region gene segment. Optionally, the        antibody or fragment comprises an IGHG2*01 human heavy chain        constant region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   In an example, said antibody or antibody fragment has been        determined to specifically bind a proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising a said PCSK9 mutation (eg, I474V or E670G) in        SEQ ID NO: 1, wherein the antibody or fragment comprises a human        gamma-2 heavy chain constant region that comprises a Pro        corresponding to position 72 of SEQ ID NO: 44, an Asn        corresponding to position 75 of SEQ ID NO: 44, a Phe        corresponding to position 76 of SEQ ID NO: 44, a Val        corresponding to position 161 of SEQ ID NO: 44 and an Ala        corresponding to position 257 of SEQ ID NO: 44 and wherein said        human comprises (i) an IGHG2*01 human heavy chain constant        region gene segment and (ii) a nucleotide sequence encoding said        proprotein convertase subtilisin/kexin type 9 (PCSK9) that        comprises a C-terminal domain comprising said mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   2. The antibody or antibody fragment of paragraph 1, wherein the    antibody comprises a human gamma-2 heavy chain constant region that    comprises a Pro corresponding to position 72 of SEQ ID NO: 44, an    Asn corresponding to position 75 of SEQ ID NO: 44, a Phe    corresponding to position 76 of SEQ ID NO: 44, a Val corresponding    to position 161 of SEQ ID NO: 44 and an Ala corresponding to    position 257 of SEQ ID NO: 44.-   3. The antibody or antibody fragment of paragraph 1 or 2, wherein    the antibody comprises an

IGHG2*01 human heavy chain constant region.

-   4. The antibody or antibody fragment of any one of paragraphs 1 to    3, wherein the human has been determined to comprise the nucleotide    sequence that encodes a PCSK9 comprising a C-terminal domain    comprising said mutation (eg, I474V or E670G) in SEQ ID NO: 1 and/or    a proprotein convertase subtilisin/kexin type 9 (PCSK9) variant    protein encoded by the nucleotide sequence of SEQ ID NO: 29 or 30.-   5. The antibody or antibody fragment of any one of paragraphs 1 to    4, the method comprising the step of determining that the human    comprises the nucleotide sequence that encodes a PCSK9 comprising a    C-terminal domain comprising said mutation (eg, I474V or E670G)    and/or a proprotein convertase subtilisin/kexin type 9 (PCSK9)    variant protein comprising said mutation (eg, I474V or E670G),    optionally, wherein the determining step is performed before    administration of the antibody to the human.-   6. The antibody or antibody fragment of paragraph 5, wherein the    step of determining comprises assaying a biological sample from the    human for a nucleotide sequence encoding the PCSK9 that comprises    the C-terminal domain comprising the mutation (eg, I474V or E670G)    in SEQ ID NO: 1.-   7. The antibody or antibody fragment of paragraph 6, wherein the    assaying comprises contacting the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and detecting the presence or        absence of the complex, wherein detecting the presence of the        complex determines that the human comprises the PCSK9 that        comprises the C-terminal domain comprising the mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   8. The antibody or antibody fragment of paragraph 6 or 7, wherein    the assaying comprises nucleic acid amplification and optionally one    or more methods selected from sequencing, next generation    sequencing, nucleic acid hybridization, and allele-specific    amplification and/or wherein the assaying is performed in a    multiplex format.-   9. The antibody or antibody fragment of any one of paragraphs 1 to    8, wherein said antibody or antibody fragment is for administration    to a human that is or has been further determined to be    substantially resistant to statin treatment.-   10. The antibody or antibody fragment of any one of paragraphs 1 to    9, wherein antibody or antibody fragment is for administration to a    human that is receiving or has received statin treatment or has    reduced responsiveness to statin treatment.-   11. The antibody or antibody fragment of paragraph 9 or 10, wherein    said antibody or antibody fragment is for administration to the    human separately or simultaneously with said statin treatment.-   12. The antibody or antibody fragment of any one of paragraphs 6 to    8, wherein said biological sample comprises serum, blood, faeces,    tissue, a cell, urine and/or saliva of said human.-   13. The antibody or antibody fragment of any one of paragraphs 1 to    12, wherein said human is indicated as heterozygous for a nucleotide    sequence encoding the PCSK9 C-terminal domain comprising a said    PCSK9 mutation (eg, I474V or E670G), optionally, wherein said human    is further indicated as comprising the nucleotide sequence of SEQ ID    NO: 28, or said human is indicated as homozygous for a nucleotide    sequence encoding the PCSK9 C-terminal domain comprising a mutation    I474V or E670G in SEQ ID NO: 1.-   14. The antibody or antibody fragment of any one of paragraphs 1 to    13, wherein said human has been diagnosed with at least one    condition selected from a lipid disorder, hyperlipoproteinemia,    hyperlipidemia, dyslipidemia, hypercholesterolemia, a heart attack,    a stroke, coronary heart disease, atherosclerosis, peripheral    vascular disease, claudication (eg, claudication associated with    elevated cholesterol) and high blood pressure.-   15. The antibody or antibody fragment of any one of paragraphs 1 to    14, wherein said antibody or antibody fragment treats or reduces the    risk in said human of at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   16. The antibody or antibody fragment of any one of paragraphs 1 to    15, wherein the nucleotide sequence is SEQ ID NO: 29 or 30.-   17. The antibody or antibody fragment of any one of paragraphs 1 to    16, wherein said antibody or antibody fragment is for administration    by intravenous or subcutaneous administration and/or is comprised in    an injectable preparation.

Further exemplary methods are in the paragraphs 1-18 as follows.

-   1. A method of (a) reducing cholesterol level or maintaining    previously reduced cholesterol level in a human in need thereof    or (b) targeting PCSK9 in a human,    -   the method comprising administering to said human an antibody or        antibody fragment that specifically binds a proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising a said PCSK9 mutation (eg, I474V or        E670G) in SEQ ID NO: 1, wherein the antibody or fragment        comprises a human gamma-2 heavy chain constant region that        comprises an amino acid selected from the group consisting of a        Pro corresponding to position 72 of SEQ ID NO: 44, an Asn        corresponding to position 75 of SEQ ID NO: 44, a Phe        corresponding to position 76 of SEQ ID NO: 44, a Val        corresponding to position 161 of SEQ ID NO: 44 and an Ala        corresponding to position 257 of SEQ ID NO: 44 and wherein said        human comprises (i) an IGHG2*01 human heavy chain constant        region gene segment, or the human expresses antibodies        comprising human gamma-2 heavy chain constant regions comprising        such a Pro, Asn, Phe, Val and Ala and (ii) a nucleotide sequence        encoding said proprotein convertase subtilisin/kexin type 9        (PCSK9) that comprises a C-terminal domain comprising said        mutation (eg, I474V or E670G) in SEQ ID NO: 1.    -   In an embodiment, said mutation is I474V. In another embodiment,        said mutation is E670G.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   An example provides:—    -   A method of (a) reducing cholesterol level or maintaining        previously reduced cholesterol level in a human in need thereof        or (b) targeting PCSK9 in a human,    -   the method comprising administering to said human an antibody or        antibody fragment that specifically binds a proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising a mutation I474 in SEQ ID NO: 1,        wherein the antibody or fragment comprises a human gamma-2 heavy        chain constant region that comprises a Pro corresponding to        position 72 of SEQ ID NO: 44, an Asn corresponding to position        75 of SEQ ID NO: 44, a Phe corresponding to position 76 of SEQ        ID NO: 44, a Val corresponding to position 161 of SEQ ID NO: 44        and an Ala corresponding to position 257 of SEQ ID NO: 44 and        wherein said human comprises (i) an IGHG2*01 human heavy chain        constant region gene segment and (ii) a nucleotide sequence        encoding said proprotein convertase subtilisin/kexin type 9        (PCSK9) that comprises a C-terminal domain comprising said        mutation I474V in SEQ ID NO: 1. Optionally, the antibody or        fragment comprises an IGHG2*01 human heavy chain constant        region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   Another example provides:—    -   A method of (a) reducing cholesterol level or maintaining        previously reduced cholesterol level in a human in need thereof        or (b) targeting PCSK9 in a human,    -   the method comprising administering to said human an antibody or        antibody fragment that specifically binds a proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising a mutation E670G in SEQ ID NO: 1,        wherein the antibody or fragment comprises a human gamma-2 heavy        chain constant region that comprises a Pro corresponding to        position 72 of SEQ ID NO: 44, an Asn corresponding to position        75 of SEQ ID NO: 44, a Phe corresponding to position 76 of SEQ        ID NO: 44, a Val corresponding to position 161 of SEQ ID NO: 44        and an Ala corresponding to position 257 of SEQ ID NO: 44 and        wherein said human comprises (i) an IGHG2*01 human heavy chain        constant region gene segment and (ii) a nucleotide sequence        encoding said proprotein convertase subtilisin/kexin type 9        (PCSK9) that comprises a C-terminal domain comprising said        mutation E670G in SEQ ID NO: 1. Optionally, the antibody or        fragment comprises an IGHG2*01 human heavy chain constant        region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   In an example, said antibody or antibody fragment has been        determined to specifically bind a proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising a said PCSK9 mutation (eg, I474V or E670G) in        SEQ ID NO: 1, wherein the antibody or fragment comprises a human        gamma-2 heavy chain constant region that comprises a Pro        corresponding to position 72 of SEQ ID NO: 44, an Asn        corresponding to position 75 of SEQ ID NO: 44, a Phe        corresponding to position 76 of SEQ ID NO: 44, a Val        corresponding to position 161 of SEQ ID NO: 44 and an Ala        corresponding to position 257 of SEQ ID NO: 44 and wherein said        human comprises (i) an IGHG2*01 human heavy chain constant        region gene segment and (ii) a nucleotide sequence encoding said        proprotein convertase subtilisin/kexin type 9 (PCSK9) that        comprises a C-terminal domain comprising said mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   2. The method of paragraph 1, comprising, before said administering,    selecting said human comprising said nucleotide sequence of (ii).-   3. The method of paragraph 1 or 2, wherein the antibody comprises a    human gamma-1 heavy chain constant region that comprises a Pro    corresponding to position 72 of SEQ ID NO: 44, an Asn corresponding    to position 75 of SEQ ID NO: 44, a Phe corresponding to position 76    of SEQ ID NO: 44, a Val corresponding to position 161 of SEQ ID NO:    44 and an Ala corresponding to position 257 of SEQ ID NO: 44.-   4. The method of paragraph 1, 2 or 3, wherein the antibody comprises    an IGHG2*01 human heavy chain constant region.-   5. The method of any one of paragraphs 1 to 4, wherein the human has    been determined to comprise the nucleotide sequence that encodes a    PCSK9 comprising a C-terminal domain comprising said mutation (eg,    I474V or E670G) in SEQ ID NO: 1 and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein encoded by the    nucleotide sequence of SEQ ID NO: 29 or 30.-   6. The method of any one of paragraphs 1 to 5, comprising the step    of determining that the human comprises the nucleotide sequence that    encodes a PCSK9 comprising a C-terminal domain comprising said    mutation (eg, I474V or E670G) and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein comprising said    mutation (eg, I474V or E670G), optionally, wherein the determining    step is performed before administration of the antibody to the    human.-   7. The method of paragraph 6, wherein the step of determining    comprises assaying a biological sample from the human for a    nucleotide sequence encoding the PCSK9 that comprises the C-terminal    domain comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1.-   8. The method of paragraph 7, wherein the assaying comprises    contacting the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and detecting the presence or        absence of the complex, wherein detecting the presence of the        complex determines that the human comprises the PCSK9 that        comprises the C-terminal domain comprising the mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   9. The method of paragraph 7 or 8, wherein the assaying comprises    nucleic acid amplification and optionally one or more methods    selected from sequencing, next generation sequencing, nucleic acid    hybridization, and allele-specific amplification and/or wherein the    assaying is performed in a multiplex format.-   10. The method of any one of paragraphs 1 to 9, wherein said human    is or has been further determined to be substantially resistant to    statin treatment.-   11. The method of any one of paragraphs 1 to 10, wherein said human    is receiving or has received statin treatment or has reduced    responsiveness to statin treatment.-   12. The method of paragraph 10 or 11, wherein said antibody or    antibody fragment is administered to the human separately or    simultaneously with said statin treatment.-   13. The method of any one of paragraphs 7 to 9, wherein said    biological sample comprises serum, blood, faeces, tissue, a cell,    urine and/or saliva of said human.-   14. The method of any one of paragraphs 1 to 13, wherein said human    is indicated as heterozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation (eg, I474V or    E670G), optionally, wherein said human is further indicated as    comprising the nucleotide sequence of SEQ ID NO: 28, or said human    is indicated as homozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation I474V or E670G in    SEQ ID NO: 1.-   15. The method of any one of paragraphs 1 to 14, wherein said human    has been diagnosed with at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   16. The method of any one of paragraphs 1 to 15, wherein said    antibody or antibody fragment treats or reduces the risk in said    human of at least one condition selected from a lipid disorder,    hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   17. The method of any one of paragraphs 1 to 16, wherein the    nucleotide sequence s SEQ ID NO: 29 or 30.-   18. The method of any one of paragraphs 1 to 17, wherein said    antibody or antibody fragment is administered by intravenous or    subcutaneous administration and/or is comprised in an injectable    preparation.

Further exemplary ligands are in the paragraphs 1-17 as follows.

-   1. An antibody or antibody fragment for use in a method of (a)    reducing cholesterol level or maintaining previously reduced    cholesterol level in a human in need thereof or (b) targeting PCSK9    in a human,    -   wherein the antibody or fragment comprises a human kappa light        chain constant region that comprises a Val corresponding to        position 84 of SEQ ID NO: 50 or a Cys corresponding to position        87 of SEQ ID NO: 50, and the antibody or fragment specifically        binds a proprotein convertase subtilisin/kexin type 9 (PCSK9)        amino acid sequence that comprises a C-terminal domain        comprising a said PCSK9 mutation (eg, I474V or E670G) in SEQ ID        NO:1, wherein the human comprises a nucleotide sequence encoding        said amino acid sequence and comprises an IGKC*01 human light        chain constant region gene segment, or the human expresses        antibodies comprising human kappa light chain constant regions        comprising such an Val and Cys.    -   In an embodiment, said mutation is I474V. In another embodiment,        said mutation is E670G.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   An example provides:—    -   An antibody or antibody fragment for use in a method of (a)        reducing cholesterol level or maintaining previously reduced        cholesterol level in a human in need thereof or (b) targeting        PCSK9 in a human,    -   wherein the antibody or fragment comprises a human kappa light        chain constant region that comprises a Val corresponding to        position 84 of SEQ ID NO: 50 and a Cys corresponding to position        87 of SEQ ID NO: 50, and the antibody or fragment specifically        binds a proprotein convertase subtilisin/kexin type 9 (PCSK9)        amino acid sequence that comprises a C-terminal domain        comprising a mutation I474V in SEQ ID NO:1, wherein the human        comprises a nucleotide sequence encoding said amino acid        sequence and comprises an IGKC*01 human light chain constant        region gene segment. Optionally, the antibody or fragment        comprises an IGKC*01 human light chain constant region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   Another example provides:—    -   An antibody or antibody fragment for use in a method of (a)        reducing cholesterol level or maintaining previously reduced        cholesterol level in a human in need thereof or (b) targeting        PCSK9 in a human,    -   wherein the antibody or fragment comprises a human kappa light        chain constant region that comprises a Val corresponding to        position 84 of SEQ ID NO: 50 and a Cys corresponding to position        87 of SEQ ID NO: 50, and the antibody or fragment specifically        binds a proprotein convertase subtilisin/kexin type 9 (PCSK9)        amino acid sequence that comprises a C-terminal domain        comprising a mutation E670G in SEQ ID NO:1, wherein the human        comprises a nucleotide sequence encoding said amino acid        sequence and comprises an IGKC*01 human light chain constant        region gene segment. Optionally, the antibody or fragment        comprises an IGKC*01 human light chain constant region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   In an example, said antibody or antibody fragment has been        determined to specifically bind a proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising a said PCSK9 mutation (eg, I474V or E670G) in        SEQ ID NO: 1, wherein the antibody or fragment comprises a human        kappa light chain constant region that comprises a Val        corresponding to position 84 of SEQ ID NO: 50 and a Cys        corresponding to position 87 of SEQ ID NO: 50 and wherein said        human comprises (i) an IGKC*01 human heavy chain constant region        gene segment and (ii) a nucleotide sequence encoding said        proprotein convertase subtilisin/kexin type 9 (PCSK9) that        comprises a C-terminal domain comprising said mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   2. The antibody or antibody fragment of paragraph 1, wherein the    antibody comprises a human kappa light chain constant region that    comprises a Val corresponding to position 84 of SEQ ID NO: 50 or a    Cys corresponding to position 87 of SEQ ID NO: 50.-   3. The antibody or antibody fragment of paragraph 1 or 2, wherein    the antibody comprises an IGKC*01 human kappa chain constant region.-   4. The antibody or antibody fragment of any one of paragraphs 1 to    3, wherein the human has been determined to comprise the nucleotide    sequence that encodes a PCSK9 comprising a C-terminal domain    comprising said mutation (eg, I474V or E670G) in SEQ ID NO: 1 and/or    a proprotein convertase subtilisin/kexin type 9 (PCSK9) variant    protein encoded by the nucleotide sequence of SEQ ID NO: 29 or 30.-   5. The antibody or antibody fragment of any one of paragraphs 1 to    4, the method comprising the step of determining that the human    comprises the nucleotide sequence that encodes a PCSK9 comprising a    C-terminal domain comprising said mutation (eg, I474V or E670G)    and/or a proprotein convertase subtilisin/kexin type 9 (PCSK9)    variant protein comprising said mutation (eg, I474V or E670G),    optionally, wherein the determining step is performed before    administration of the antibody to the human.-   6. The antibody or antibody fragment of paragraph 5, wherein the    step of determining comprises assaying a biological sample from the    human for a nucleotide sequence encoding the PCSK9 that comprises    the C-terminal domain comprising the mutation (eg, I474V or E670G)    in SEQ ID NO: 1.-   7. The antibody or antibody fragment of paragraph 6, wherein the    assaying comprises contacting the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1.-   8. The antibody or antibody fragment of paragraph 6 or 7, wherein    the assaying comprises nucleic acid amplification and optionally one    or more methods selected from sequencing, next generation    sequencing, nucleic acid hybridization, and allele-specific    amplification and/or wherein the assaying is performed in a    multiplex format.-   9. The antibody or antibody fragment of any one of paragraphs 1 to    8, wherein said antibody or antibody fragment is for administration    to a human that is or has been further determined to be    substantially resistant to statin treatment.-   10. The antibody or antibody fragment of any one of paragraphs 1 to    9, wherein antibody or antibody fragment is for administration to a    human that is receiving or has received statin treatment or has    reduced responsiveness to statin treatment.-   11. The antibody or antibody fragment of paragraph 9 or 10, wherein    said antibody or antibody fragment is for administration to the    human separately or simultaneously with said statin treatment.-   12. The antibody or antibody fragment of any one of paragraphs 6 to    10, wherein said biological sample comprises serum, blood, faeces,    tissue, a cell, urine and/or saliva of said human.-   13. The antibody or antibody fragment of any one of paragraphs 1 to    12, wherein said human is indicated as heterozygous for a nucleotide    sequence encoding the PCSK9 C-terminal domain comprising a said    PCSK9 mutation (eg, I474V or E670G), optionally, wherein said human    is further indicated as comprising the nucleotide sequence of SEQ ID    NO: 28, or said human is indicated as homozygous for a nucleotide    sequence encoding the PCSK9 C-terminal domain comprising a mutation    I474V or E670G in SEQ ID NO: 1.-   14. The antibody or antibody fragment of any one of paragraphs 1 to    13, wherein said human has been diagnosed with at least one    condition selected from a lipid disorder, hyperlipoproteinemia,    hyperlipidemia, dyslipidemia, hypercholesterolemia, a heart attack,    a stroke, coronary heart disease, atherosclerosis, peripheral    vascular disease, claudication (eg, claudication associated with    elevated cholesterol) and high blood pressure.-   15. The antibody or antibody fragment of any one of paragraphs 1 to    14, wherein said antibody or antibody fragment treats or reduces the    risk in said human of at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   16. The antibody or antibody fragment of any one of paragraphs 1 to    15, wherein the nucleotide sequence is SEQ ID NO: 29 or 30.-   17. The antibody or antibody fragment of any one of paragraphs 1 to    16, wherein said antibody or antibody fragment is for administration    by intravenous or subcutaneous administration and/or is comprised in    an injectable preparation.

Further exemplary methods are in the paragraphs 1-18 as follows.

-   1. A method of (a) reducing cholesterol level or maintaining    previously reduced cholesterol level in a human in need thereof    or (b) targeting PCSK9 in a human,    -   the method comprising administering to said human an antibody or        antibody fragment that specifically binds a proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising a said PCSK9 mutation (eg, I474V or        E670G) in SEQ ID NO: 1, wherein the antibody or fragment        comprises a human kappa light chain constant region that        comprises a Val corresponding to position 84 of SEQ ID NO: 50 or        a Cys corresponding to position 87 of SEQ ID NO: 50 and wherein        said human comprises (i) an IGKC*01 human light chain constant        region gene segment, or the human expresses antibodies        comprising human kappa light chain constant regions comprising        such an Val and Cys and (ii) a nucleotide sequence encoding said        proprotein convertase subtilisin/kexin type 9 (PCSK9) that        comprises a C-terminal domain comprising said mutation (eg,        I474V or E670G) in SEQ ID NO: 1.    -   In an embodiment, said mutation is I474V. In another embodiment,        said mutation is E670G.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   An example provides:—    -   A method of (a) reducing cholesterol level or maintaining        previously reduced cholesterol level in a human in need thereof        or (b) targeting PCSK9 in a human,    -   the method comprising administering to said human an antibody or        antibody fragment that specifically binds a proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising a mutation I474 in SEQ ID NO: 1,        wherein the antibody or fragment comprises a human kappa light        chain constant region that comprises a Val corresponding to        position 84 of SEQ ID NO: 50 and a Cys corresponding to position        87 of SEQ ID NO: 50 and wherein said human comprises (i) an        IGKC*01 human light chain constant region gene segment and (ii)        a nucleotide sequence encoding said proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising said mutation I474V in SEQ ID NO: 1.        Optionally, the antibody or fragment comprises an IGKC*01 human        light chain constant region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   Another example provides:—    -   A method of (a) reducing cholesterol level or maintaining        previously reduced cholesterol level in a human in need thereof        or (b) targeting PCSK9 in a human,    -   the method comprising administering to said human an antibody or        antibody fragment that specifically binds a proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising a mutation E670G in SEQ ID NO: 1,        wherein the antibody or fragment comprises a human kappa light        chain constant region that comprises a Val corresponding to        position 84 of SEQ ID NO: 50 and a Cys corresponding to position        87 of SEQ ID NO: 50 and wherein said human comprises (i) an        IGKC*01 human light chain constant region gene segment and (ii)        a nucleotide sequence encoding said proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising said mutation E670G in SEQ ID NO: 1.        Optionally, the antibody or fragment comprises an IGKC*01 human        light chain constant region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   In an example, said antibody or antibody fragment has been        determined to specifically bind a proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising a said PCSK9 mutation (eg, I474V or E670G) in        SEQ ID NO: 1, wherein the antibody or fragment comprises a human        kappa light chain constant region that comprises a Val        corresponding to position 84 of SEQ ID NO: 50 and a Cys        corresponding to position 87 of SEQ ID NO: 50 and wherein said        human comprises (i) an IGKC*01 human heavy chain constant region        gene segment and (ii) a nucleotide sequence encoding said        proprotein convertase subtilisin/kexin type 9 (PCSK9) that        comprises a C-terminal domain comprising said mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   2. The method of paragraph 1, comprising, before said administering,    selecting said human comprising said nucleotide sequence of (ii).-   3. The method of paragraph 1 or 2, wherein the antibody comprises a    human kappa light chain constant region that comprises a Val    corresponding to position 84 of SEQ ID NO: 50 or a Cys corresponding    to position 87 of SEQ ID NO: 50.-   4. The method of paragraph 1, 2 or 3, wherein the antibody comprises    an IGKC*01 human kappa chain constant region.-   5. The method of any one of paragraphs 1 to 4, wherein the human has    been determined to comprise the nucleotide sequence that encodes a    PCSK9 comprising a C-terminal domain comprising said mutation (eg,    I474V or E670G) in SEQ ID NO: 1 and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein encoded by the    nucleotide sequence of SEQ ID NO: 29 or 30.-   6. The method of any one of paragraphs 1 to 5, comprising the step    of determining that the human comprises the nucleotide sequence that    encodes a PCSK9 comprising a C-terminal domain comprising said    mutation (eg, I474V or E670G) and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein comprising said    mutation (eg, I474V or E670G), optionally, wherein the determining    step is performed before administration of the antibody to the    human.-   7. The method of paragraph 6, wherein the step of determining    comprises assaying a biological sample from the human for a    nucleotide sequence encoding the PCSK9 that comprises the C-terminal    domain comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1.-   8. The method of paragraph 7, wherein the assaying comprises    contacting the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and detecting the presence or        absence of the complex, wherein detecting the presence of the        complex determines that the human comprises the PCSK9 that        comprises the C-terminal domain comprising the mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   9. The method of paragraph 7 or 8, wherein the assaying comprises    nucleic acid amplification and optionally one or more methods    selected from sequencing, next generation sequencing, nucleic acid    hybridization, and allele-specific amplification and/or wherein the    assaying is performed in a multiplex format.-   10. The method of any one of paragraphs 1 to 9, wherein said human    is or has been further determined to be substantially resistant to    statin treatment.-   11. The method of any one of paragraphs 1 to 10, wherein said human    is receiving or has received statin treatment or has reduced    responsiveness to statin treatment.-   12. The method of paragraph 10 or 11, wherein said antibody or    antibody fragment is administered to the human separately or    simultaneously with said statin treatment.-   13. The method of any one of paragraphs 7 to 9, wherein said    biological sample comprises serum, blood, faeces, tissue, a cell,    urine and/or saliva of said human.

14. The method of any one of paragraphs 1 to 13, wherein said human isindicated as heterozygous for a nucleotide sequence encoding the PCSK9C-terminal domain comprising said mutation (eg, I474V or E670G),optionally, wherein said human is further indicated as comprising thenucleotide sequence of SEQ ID NO: 28, or said human is indicated ashomozygous for a nucleotide sequence encoding the PCSK9 C-terminaldomain comprising said mutation I474V or E670G in SEQ ID NO: 1.

-   15. The method of any one of paragraphs 1 to 14, wherein said human    has been diagnosed with at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   16. The method of any one of paragraphs 1 to 15, wherein said    antibody or antibody fragment treats or reduces the risk in said    human of at least one condition selected from a lipid disorder,    hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   17. The method of any one of paragraphs 1 to 16, wherein the    nucleotide sequence is SEQ ID NO: 29 or 30.-   18. The method of any one of paragraphs 1 to 17, wherein said    antibody or antibody fragment is administered by intravenous or    subcutaneous administration and/or is comprised in an injectable    preparation.

Further exemplary ligands are in the paragraphs 1-15 as follows.

-   1. An antibody or antibody fragment for use in a method of (a)    reducing cholesterol level or maintaining previously reduced    cholesterol level in a human in need thereof or (b) targeting PCSK9    in a human,    -   wherein the antibody or fragment comprises a human IGLC2*01        lambda light chain constant region, and the antibody or fragment        specifically binds a proprotein convertase subtilisin/kexin type        9 (PCSK9) amino acid sequence that comprises a C-terminal domain        comprising a said PCSK9 mutation (eg, I474V or E670G) in SEQ ID        NO:1, wherein the human comprises a nucleotide sequence encoding        said amino acid sequence and comprises a human IGLC2*01 lambda        light chain constant region gene segment, or the human expresses        antibodies comprising human IGLC2*01 lambda light chain constant        regions.    -   In an embodiment, said mutation is I474V. In another embodiment,        said mutation is E670G.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   An example provides:—    -   An antibody or antibody fragment for use in a method of (a)        reducing cholesterol level or maintaining previously reduced        cholesterol level in a human in need thereof or (b) targeting        PCSK9 in a human,    -   wherein the antibody or fragment comprises a human IGLC2*01        lambda light chain constant region, and the antibody or fragment        specifically binds a proprotein convertase subtilisin/kexin type        9 (PCSK9) amino acid sequence that comprises a C-terminal domain        comprising a mutation I474V in SEQ ID NO:1, wherein the human        comprises a nucleotide sequence encoding said amino acid        sequence and comprises a human IGLC2*01 lambda light chain        constant region gene segment. Optionally, the antibody or        fragment comprises a human IGLC2*01 lambda light chain constant        region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   Another example provides:—    -   An antibody or antibody fragment for use in a method of (a)        reducing cholesterol level or maintaining previously reduced        cholesterol level in a human in need thereof or (b) targeting        PCSK9 in a human,    -   wherein the antibody or fragment comprises a human IGLC2*01        lambda light chain constant region, and the antibody or fragment        specifically binds a proprotein convertase subtilisin/kexin type        9 (PCSK9) amino acid sequence that comprises a C-terminal domain        comprising a mutation E670G in SEQ ID NO:1, wherein the human        comprises a nucleotide sequence encoding said amino acid        sequence and comprises a human IGLC2*01 lambda light chain        constant region gene segment. Optionally, the antibody or        fragment comprises a human IGLC2*01 lambda light chain constant        region.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.    -   In an example, said antibody or antibody fragment has been        determined to specifically bind a proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising a said PCSK9 mutation (eg, I474V or E670G) in        SEQ ID NO: 1, wherein the antibody or fragment comprises a human        IGLC2*01 lambda light chain constant region and wherein said        human comprises (i) an IGLC2*01 human heavy chain constant        region gene segment and (ii) a nucleotide sequence encoding said        proprotein convertase subtilisin/kexin type 9 (PCSK9) that        comprises a C-terminal domain comprising said mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   2. The antibody or antibody fragment of paragraph 1, wherein the    human has been determined to comprise the nucleotide sequence that    encodes a PCSK9 comprising a C-terminal domain comprising said    mutation (eg, I474V or E670G) in SEQ ID NO: 1 and/or a proprotein    convertase subtilisin/kexin type 9 (PCSK9) variant protein encoded    by the nucleotide sequence of SEQ ID NO: 29 or 30.-   3. The antibody or antibody fragment of paragraphs 1 or 2, the    method comprising the step of determining that the human comprises    the nucleotide sequence that encodes a PCSK9 comprising a C-terminal    domain comprising said mutation (eg, I474V or E670G) and/or a    proprotein convertase subtilisin/kexin type 9 (PCSK9) variant    protein comprising said mutation (eg, I474V or E670G), optionally,    wherein the determining step is performed before administration of    the antibody to the human.-   4. The antibody or antibody fragment of paragraph 3, wherein the    step of determining comprises assaying a biological sample from the    human for a nucleotide sequence encoding the PCSK9 that comprises    the C-terminal domain comprising the mutation (eg, I474V or E670G)    in SEQ ID NO: 1.-   5. The antibody or antibody fragment of paragraph 4, wherein the    assaying comprises contacting the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1.-   6. The antibody or antibody fragment of paragraph 4 or 5, wherein    the assaying comprises nucleic acid amplification and optionally one    or more methods selected from sequencing, next generation    sequencing, nucleic acid hybridization, and allele-specific    amplification and/or wherein the assaying is performed in a    multiplex format.-   7. The antibody or antibody fragment of any one of paragraphs 1 to    6, wherein said antibody or antibody fragment is for administration    to a human that is or has been further determined to be    substantially resistant to statin treatment.-   8. The antibody or antibody fragment of any one of paragraphs 1 to    7, wherein antibody or antibody fragment is for administration to a    human that is receiving or has received statin treatment or has    reduced responsiveness to statin treatment.-   9. The antibody or antibody fragment of paragraph 7 or 8, wherein    said antibody or antibody fragment is for administration to the    human separately or simultaneously with said statin treatment.-   10. The antibody or antibody fragment of any one of paragraphs 4 to    8, wherein said biological sample comprises serum, blood, faeces,    tissue, a cell, urine and/or saliva of said human.-   11. The antibody or antibody fragment of any one of paragraphs 1 to    10, wherein said human is indicated as heterozygous for a nucleotide    sequence encoding the PCSK9 C-terminal domain comprising a said    PCSK9 mutation (eg, I474V or E670G), optionally, wherein said human    is further indicated as comprising the nucleotide sequence of SEQ ID    NO: 28, or said human is indicated as homozygous for a nucleotide    sequence encoding the PCSK9 C-terminal domain comprising a mutation    I474V or E670G in SEQ ID NO: 1.-   12. The antibody or antibody fragment of any one of paragraphs 1 to    11, wherein said human has been diagnosed with at least one    condition selected from a lipid disorder, hyperlipoproteinemia,    hyperlipidemia, dyslipidemia, hypercholesterolemia, a heart attack,    a stroke, coronary heart disease, atherosclerosis, peripheral    vascular disease, claudication (eg, claudication associated with    elevated cholesterol) and high blood pressure.-   13. The antibody or antibody fragment of any one of paragraphs 1 to    12, wherein said antibody or antibody fragment treats or reduces the    risk in said human of at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   14. The antibody or antibody fragment of any one of paragraphs 1 to    13, wherein the nucleotide sequence is SEQ ID NO: 29 or 30.-   15. The antibody or antibody fragment of any one of paragraphs 1 to    14, wherein said antibody or antibody fragment is for administration    by intravenous or subcutaneous administration and/or is comprised in    an injectable preparation.

Further exemplary methods are in the paragraphs 1-16 as follows.

-   1. A method of reducing cholesterol level or maintaining previously    reduced cholesterol level in a human in need thereof, the method    comprising administering to said human an antibody or antibody    fragment that specifically binds a proprotein convertase    subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal domain    comprising a said PCSK9 mutation (eg, I474V or E670G) in SEQ ID NO:    1, wherein the antibody or fragment comprises a human IGLC2*01    lambda light chain constant region and wherein said human    comprises (i) an IGLC2*01 human light chain constant region gene    segment, or the human expresses antibodies comprising a human    IGLC2*01 lambda light chain constant regions and (ii) a nucleotide    sequence encoding said proprotein convertase subtilisin/kexin type 9    (PCSK9) that comprises a C-terminal domain comprising said mutation    (eg, I474V or E670G) in SEQ ID NO: 1.    -   In an embodiment, said mutation is I474V. In another embodiment,        said mutation is E670G.    -   An example provides:—    -   A method of reducing cholesterol level or maintaining previously        reduced cholesterol level in a human in need thereof, the method        comprising administering to said human an antibody or antibody        fragment that specifically binds a proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising a mutation I474 in SEQ ID NO: 1, wherein the        antibody or fragment comprises a human IGLC2*01 lambda light        chain constant region and wherein said human comprises (i) an        IGLC2*01 human light chain constant region gene segment and (ii)        a nucleotide sequence encoding said proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising said mutation I474V in SEQ ID NO: 1.        Optionally, the antibody or fragment comprises an IGLC2*01 human        light chain constant region.    -   Another example provides:—    -   A method of reducing cholesterol level or maintaining previously        reduced cholesterol level in a human in need thereof, the method        comprising administering to said human an antibody or antibody        fragment that specifically binds a proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising a mutation E670G in SEQ ID NO: 1, wherein the        antibody or fragment comprises a human IGLC2*01 lambda light        chain constant region and wherein said human comprises (i) an        IGLC2*01 human light chain constant region gene segment and (ii)        a nucleotide sequence encoding said proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising said mutation E670G in SEQ ID NO: 1.        Optionally, the antibody or fragment comprises an IGLC2*01 human        light chain constant region.    -   In an example, said antibody or antibody fragment has been        determined to specifically bind a proprotein convertase        subtilisin/kexin type 9 (PCSK9) that comprises a C-terminal        domain comprising a said PCSK9 mutation (eg, I474V or E670G) in        SEQ ID NO: 1, wherein the antibody or fragment comprises a human        IGLC2*01 lambda light chain constant region and wherein said        human comprises (i) an IGLC2*01 human heavy chain constant        region gene segment and (ii) a nucleotide sequence encoding said        proprotein convertase subtilisin/kexin type 9 (PCSK9) that        comprises a C-terminal domain comprising said mutation (eg,        I474V or E670G) in SEQ ID NO: 1-   2. The method of paragraph 1, comprising, before said administering,    selecting said human comprising said nucleotide sequence of (ii).-   3. The method of paragraph 1 or 2, wherein the human has been    determined to comprise the nucleotide sequence that encodes a PCSK9    comprising a C-terminal domain comprising said mutation (eg, I474V    or E670G) in SEQ ID NO: 1 and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein encoded by the    nucleotide sequence of SEQ ID NO: 29 or 30.-   4. The method of any one of paragraphs 1 to 3, comprising the step    of determining that the human comprises the nucleotide sequence that    encodes a PCSK9 comprising a C-terminal domain comprising said    mutation (eg, I474V or E670G) and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein comprising said    mutation (eg, I474V or E670G), optionally, wherein the determining    step is performed before administration of the antibody to the    human.-   5. The method of paragraph 4, wherein the step of determining    comprises assaying a biological sample from the human for a    nucleotide sequence encoding the PCSK9 that comprises the C-terminal    domain comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1.-   6. The method of paragraph 5, wherein the assaying comprises    contacting the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and detecting the presence or        absence of the complex, wherein detecting the presence of the        complex determines that the human comprises the PCSK9 that        comprises the C-terminal domain comprising the mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   7. The method of paragraph 5 or 6, wherein the assaying comprises    nucleic acid amplification and optionally one or more methods    selected from sequencing, next generation sequencing, nucleic acid    hybridization, and allele-specific amplification and/or wherein the    assaying is performed in a multiplex format.-   8. The method of any one of paragraphs 1 to 7, wherein said human is    or has been further determined to be substantially resistant to    statin treatment.-   9. The method of any one of paragraphs 1 to 8, wherein said human is    receiving or has received statin treatment or has reduced    responsiveness to statin treatment.-   10. The method of paragraph 8 or 9, wherein said antibody or    antibody fragment is administered to the human separately or    simultaneously with said statin treatment.-   11. The method of any one of paragraphs 5 to 7, wherein said    biological sample comprises serum, blood, faeces, tissue, a cell,    urine and/or saliva of said human.-   12. The method of any one of paragraphs 1 to 11, wherein said human    is indicated as heterozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation (eg, I474V or    E670G), optionally, wherein said human is further indicated as    comprising the nucleotide sequence of SEQ ID NO: 28, or said human    is indicated as homozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation I474V or E670G in    SEQ ID NO: 1.-   13. The method of any one of paragraphs 1 to 12, wherein said human    has been diagnosed with at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   14. The method of any one of paragraphs 1 to 13, wherein said    antibody or antibody fragment treats or reduces the risk in said    human of at least one condition selected from a lipid disorder,    hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   15. The method of any one of paragraphs 1 to 14, wherein the    nucleotide sequence is SEQ ID NO: 29 or 30.-   16. The method of any one of paragraphs 1 to 15, wherein said    antibody or antibody fragment is administered by intravenous or    subcutaneous administration and/or is comprised in an injectable    preparation.

Further exemplary ligands are in the paragraphs 1-15 as follows.

-   1. An antibody or antibody fragment for use in a method of (a)    reducing cholesterol level or maintaining previously reduced    cholesterol level in a human in need thereof or (b) targeting PCSK9    in a human, wherein the antibody or fragment comprises a human    variable domain that is derived from the recombination of a human VH    gene segment, a human D gene segment and a human JH gene segment,    wherein the VH gene segment is as defined in any one of clauses 80    to 90, and the antibody or fragment specifically binds a proprotein    convertase subtilisin/kexin type 9 (PCSK9) amino acid sequence that    comprises a C-terminal domain comprising a said PCSK9 mutation (eg,    I474V or E670G) in SEQ ID NO:1, wherein the human comprises a    nucleotide sequence encoding said amino acid sequence, and comprises    said VH gene segment or expresses antibodies comprising VH domains    that are derived from the recombination of said human VH gene    segment, a human D gene segment and a human JH gene segment.    -   In an embodiment, said mutation is I474V. In another embodiment,        said mutation is E670G.    -   In an embodiment of (b), the antibody or fragment treats or        reduces cholesterol level or maintains previously reduced        cholesterol level in the human.-   2. The antibody or antibody fragment of paragraph 1, wherein the    human has been determined to comprise the nucleotide sequence that    encodes a PCSK9 comprising a C-terminal domain comprising said    mutation (eg, I474V or E670G) in SEQ ID NO: 1 and/or a proprotein    convertase subtilisin/kexin type 9 (PCSK9) variant protein encoded    by the nucleotide sequence of SEQ ID NO: 29 or 30.-   3. The antibody or antibody fragment of paragraphs 1 or 2, the    method comprising the step of determining that the human comprises    the nucleotide sequence that encodes a PCSK9 comprising a C-terminal    domain comprising said mutation (eg, I474V or E670G) and/or a    proprotein convertase subtilisin/kexin type 9 (PCSK9) variant    protein comprising said mutation (eg, I474V or E670G), optionally,    wherein the determining step is performed before administration of    the antibody to the human.-   4. The antibody or antibody fragment of paragraph 3, wherein the    step of determining comprises assaying a biological sample from the    human for a nucleotide sequence encoding the PCSK9 that comprises    the C-terminal domain comprising the mutation (eg, I474V or E670G)    in SEQ ID NO: 1.-   5. The antibody or antibody fragment of paragraph 4, wherein the    assaying comprises contacting the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1.-   6. The antibody or antibody fragment of paragraph 4 or 5, wherein    the assaying comprises nucleic acid amplification and optionally one    or more methods selected from sequencing, next generation    sequencing, nucleic acid hybridization, and allele-specific    amplification and/or wherein the assaying is performed in a    multiplex format.-   7. The antibody or antibody fragment of any one of paragraphs 1 to    6, wherein said antibody or antibody fragment is for administration    to a human that is or has been further determined to be    substantially resistant to statin treatment.-   8. The antibody or antibody fragment of any one of paragraphs 1 to    7, wherein antibody or antibody fragment is for administration to a    human that is receiving or has received statin treatment or has    reduced responsiveness to statin treatment.-   9. The antibody or antibody fragment of paragraph 7 or 8, wherein    said antibody or antibody fragment is for administration to the    human separately or simultaneously with said statin treatment.-   10. The antibody or antibody fragment of any one of paragraphs 4 to    8, wherein said biological sample comprises serum, blood, faeces,    tissue, a cell, urine and/or saliva of said human.-   11. The antibody or antibody fragment of any one of paragraphs 1 to    10, wherein said human is indicated as heterozygous for a nucleotide    sequence encoding the PCSK9 C-terminal domain comprising a said    PCSK9 mutation (eg, I474V or E670G), optionally, wherein said human    is further indicated as comprising the nucleotide sequence of SEQ ID    NO: 28, or said human is indicated as homozygous for a nucleotide    sequence encoding the PCSK9 C-terminal domain comprising a mutation    I474V or E670G in SEQ ID NO: 1.-   12. The antibody or antibody fragment of any one of paragraphs 1 to    11, wherein said human has been diagnosed with at least one    condition selected from a lipid disorder, hyperlipoproteinemia,    hyperlipidemia, dyslipidemia, hypercholesterolemia, a heart attack,    a stroke, coronary heart disease, atherosclerosis, peripheral    vascular disease, claudication (eg, claudication associated with    elevated cholesterol) and high blood pressure.-   13. The antibody or antibody fragment of any one of paragraphs 1 to    12, wherein said antibody or antibody fragment treats or reduces the    risk in said human of at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   14. The antibody or antibody fragment of any one of paragraphs 1 to    13, wherein the nucleotide sequence is SEQ ID NO: 29 or 30.-   15. The antibody or antibody fragment of any one of paragraphs 1 to    14, wherein said antibody or antibody fragment is for administration    by intravenous or subcutaneous administration and/or is comprised in    an injectable preparation.

Further exemplary methods are in the paragraphs 1-16 as follows.

-   1. A method of (a) reducing cholesterol level or maintaining    previously reduced cholesterol level in a human in need thereof    or (b) targeting PCSK9 in a human,    -   the method comprising administering to said human an antibody or        antibody fragment that specifically binds a proprotein        convertase subtilisin/kexin type 9 (PCSK9) that comprises a        C-terminal domain comprising a said PCSK9 mutation (eg, I474V or        E670G) in SEQ ID NO: 1, wherein the antibody or fragment        comprises a human variable domain that is derived from the        recombination of a human VH gene segment, a human D gene segment        and a human JH gene segment, wherein the VH gene segment is as        defined in any one of clauses 80 to 90 and wherein said human        comprises (i) comprises said VH gene segment or expresses        antibodies comprising VH domains that are derived from the        recombination of said human VH gene segment, a human D gene        segment and a human JH gene segment and (ii) a nucleotide        sequence encoding said proprotein convertase subtilisin/kexin        type 9 (PCSK9) that comprises a C-terminal domain comprising        said mutation (eg, I474V or E670G) in SEQ ID NO: 1.

In an embodiment, said mutation is I474V. In another embodiment, saidmutation is E670G.

In an embodiment of (b), the antibody or fragment treats or reducescholesterol level or maintains previously reduced cholesterol level inthe human.

-   2. The method of paragraph 1, comprising, before said administering,    selecting said human comprising said nucleotide sequence of (ii).-   3. The method of paragraph 1 or 2, wherein the human has been    determined to comprise the nucleotide sequence that encodes a PCSK9    comprising a C-terminal domain comprising said mutation (eg, I474V    or E670G) in SEQ ID NO: 1 and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein encoded by the    nucleotide sequence of SEQ ID NO: 29 or 30.-   4. The method of any one of paragraphs 1 to 3, comprising the step    of determining that the human comprises the nucleotide sequence that    encodes a PCSK9 comprising a C-terminal domain comprising said    mutation (eg, I474V or E670G) and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein comprising said    mutation (eg, I474V or E670G), optionally, wherein the determining    step is performed before administration of the antibody to the    human.-   5. The method of paragraph 4, wherein the step of determining    comprises assaying a biological sample from the human for a    nucleotide sequence encoding the PCSK9 that comprises the C-terminal    domain comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1.-   6. The method of paragraph 5, wherein the assaying comprises    contacting the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and detecting the presence or        absence of the complex, wherein detecting the presence of the        complex determines that the human comprises the PCSK9 that        comprises the C-terminal domain comprising the mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   7. The method of paragraph 5 or 6, wherein the assaying comprises    nucleic acid amplification and optionally one or more methods    selected from sequencing, next generation sequencing, nucleic acid    hybridization, and allele-specific amplification and/or wherein the    assaying is performed in a multiplex format.-   8. The method of any one of paragraphs 1 to 7, wherein said human is    or has been further determined to be substantially resistant to    statin treatment.-   9. The method of any one of paragraphs 1 to 8, wherein said human is    receiving or has received statin treatment or has reduced    responsiveness to statin treatment.-   10. The method of paragraph 8 or 9, wherein said antibody or    antibody fragment is administered to the human separately or    simultaneously with said statin treatment.-   11. The method of any one of paragraphs 5 to 7, wherein said    biological sample comprises serum, blood, faeces, tissue, a cell,    urine and/or saliva of said human.-   12. The method of any one of paragraphs 1 to 11, wherein said human    is indicated as heterozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation (eg, I474V or    E670G), optionally, wherein said human is further indicated as    comprising the nucleotide sequence of SEQ ID NO: 28, or said human    is indicated as homozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation I474V or E670G in    SEQ ID NO: 1.-   13. The method of any one of paragraphs 1 to 12, wherein said human    has been diagnosed with at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   14. The method of any one of paragraphs 1 to 13, wherein said    antibody or antibody fragment treats or reduces the risk in said    human of at least one condition selected from a lipid disorder,    hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   15. The method of any one of paragraphs 1 to 14, wherein the    nucleotide sequence is SEQ ID NO: 29 or 30.-   16. The method of any one of paragraphs 1 to 15, wherein said    antibody or antibody fragment is administered by intravenous or    subcutaneous administration and/or is comprised in an injectable    preparation.

In an alternative, instead of being a method “of reducing cholesterollevel or maintaining previously reduced cholesterol level” as rectiedherein the method is “of treating and/or preventing a humanPCSK9-mediated condition or disease” (eg, associated with hyper- orhypocholesterolemia or any other PCSK9-mediated disease or conditiondisclosed herein) and the mutation is instead selected from the group ofR46L, A53V, N425S, A443T, I474V, Q619P and E670G. Hence in thisalternative, any such embodiment is disclosed as written herein but withthe mutation recited as selected from this group. In an example, themutation is R46L. In an example, the mutation is A53V. In an example,the mutation is N425S. In an example, the mutation is A443T. In anexample, the mutation is I474V. In an example, the mutation is Q619P. Inan example, the mutation is E670G.

Regimens

A: The invention further provides the following regimens, ligands andkits.

-   1. A method for treating a human PCSK9-mediated disease or condition    in a human by targeting a rare variant human PCSK9, the method    comprising administering to the human a ligand (eg, an antibody or    fragment) that has been determined to specifically bind to said    PCSK9variant; wherein the human expresses said PCSK9 variant or the    genome of the human comprises a nucleotide sequence encoding said    PCSK9 variant; wherein said human is treated for said disease or    condition.    -   In an alternative, clause 1 provides:—    -   A method for targeting a rare variant human PCSK9, the method        comprising administering to the human a ligand (eg, an antibody        or fragment) that has been determined to specifically bind to        said PCSK9variant; wherein the human expresses said PCSK9        variant or the genome of the human comprises a nucleotide        sequence encoding said PCSK9 variant. In an embodiment, said        human is treated for said disease or condition.        The variant PCSK9 can, for example, be any rare variant as        described herein.

For example, there is provided:

1a. A method for treating a PCSK9-mediated disease or condition in ahuman by targeting a PCSK9 that comprises a C-terminal domain amino acidpolymorphism (compared to SEQ ID NO: 1), the method comprisingadministering to the human a ligand (eg, an antibody or fragment) thathas been determined to specifically bind to a PCSK9 comprising aC-terminal domain comprising a said PCSK9 mutation (eg, I474V or 670G)(numbering according to SEQ ID NO:1); wherein the human expresses saidPCSK9 or the genome of the human comprises a nucleotide sequenceencoding said PCSK9; wherein said human is treated for said disease orcondition.

For example, there is provided:

1b. A method for targeting a PCSK9 that comprises a C-terminal domainamino acid polymorphism (compared to SEQ ID NO: 1), the methodcomprising administering to the human a ligand (eg, an antibody orfragment) that has been determined to specifically bind to a PCSK9comprising a C-terminal domain comprising a said PCSK9 mutation (eg,I474V or 670G) (numbering according to SEQ ID NO:1); wherein the humanexpresses said PCSK9 or the genome of the human comprises a nucleotidesequence encoding said PCSK9; optionally wherein said human is treatedfor said disease or condition.

In an embodiment, determination of said specific binding is by referenceto binding assay data, eg, as determined using SPR or ELISA.Determination may, for example, be by reference to information in aprinted publication, eg, with knowledge of data presented in the presentor another patent application or in a journal article. Once armed withsuch knowledge (eg, in the absence of further testing of binding), theskilled person is able—by direction of the present invention—to treat arelevant human whose genotype or phenotype matches the bindingspecificity of the ligand.The antibody or fragment can be according to any configuration, example,embodiment, aspect, clause or paragraph herein.In an embodiment, the method comprises, before said administering,selecting a human comprising said nucleotide sequence encoding thePCSK9, wherein the human is said human in clause 1 (eg, 1a).

-   2. The method of clause 1, comprising before said administering the    step of determining that the ligand specifically binds to said    PCSK9, eg, using SPR or ELISA.-   3. The method of clause 1 or 2, wherein the specific binding to said    PCSK9 is binding with a dissociation constant (Kd) of 1 nM or less,    eg, 100, 10 or 1pM or less.-   4. The method of any of clauses 1 to 3 (eg, clause la), wherein the    condition is elevated LDL-cholesterol or is caused by elevated    LDL-cholesterol.-   5. The method of clause 4 (eg, when dependent from clause 1a),    wherein the condition is selected from a lipid disorder,    hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   6. The method of any one of clauses 1 to 5 (eg, when dependent from    clause 1a), wherein the human has been determined to comprise the    nucleotide sequence that encodes a PCSK9 comprising a C-terminal    domain comprising said mutation (eg, I474V or E670G) in SEQ ID NO: 1    and/or a proprotein convertase subtilisin/kexin type 9 (PCSK9)    variant protein encoded by the nucleotide sequence of SEQ ID NO: 29    or 30.-   7. The method of any one of clauses 1 to 6 (eg, when dependent from    clause 1a), comprising the step of determining that the human    comprises the nucleotide sequence that encodes a PCSK9 comprising a    C-terminal domain comprising said mutation (eg, I474V or E670G)    and/or a proprotein convertase subtilisin/kexin type 9 (PCSK9)    variant protein comprising said mutation (eg, I474V or E670G),    optionally, wherein the determining step is performed before    administration of the antibody to the human.-   8. The method of clause 7, wherein the step of determining comprises    assaying a biological sample from the human for a nucleotide    sequence encoding the PCSK9 that comprises the C-terminal domain    comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1.-   9. The method of clause 8, wherein the assaying comprises contacting    the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and detecting the presence or        absence of the complex, wherein detecting the presence of the        complex determines that the human comprises the PCSK9 that        comprises the C-terminal domain comprising the mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   10. The method of clause 8 or 9, wherein the assaying comprises    nucleic acid amplification and optionally one or more methods    selected from sequencing, next generation sequencing, nucleic acid    hybridization, and allele-specific amplification and/or wherein the    assaying is performed in a multiplex format.-   11. The method of any one of clauses 1 to 10, wherein said human is    or has been further determined to be substantially resistant to    statin treatment.-   12. The method of any one of clauses 1 to 11, wherein said human is    receiving or has received statin treatment or has reduced    responsiveness to statin treatment.-   13. The method of clauses 11 or 12, wherein said antibody or    antibody fragment is administered to the human separately or    simultaneously with said statin treatment.-   14. The method of any one of clauses 8 to 10, wherein said    biological sample comprises serum, blood, faeces, tissue, a cell,    urine and/or saliva of said human.-   15. The method of any one of clauses 1 to 14, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation (eg, I474V or    E670G), optionally, wherein said human is further indicated as    comprising the nucleotide sequence of SEQ ID NO: 28, or said human    is indicated as homozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation I474V or E670G in    SEQ ID NO: 1.-   16. The method of any one of clauses 1 to 15, wherein said human has    been diagnosed with at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   17. The method of any one of clauses 1 to 16, wherein said antibody    or antibody fragment treats or reduces the risk in said human of at    least one condition selected from a lipid disorder,    hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   18. The method of any one of clauses 1 to 17, wherein the nucleotide    sequence is SEQ ID NO: 29 or 30.-   19. The method of any one of clauses 1 to 18, wherein said antibody    or antibody fragment is administered by intravenous or subcutaneous    administration and/or is comprised in an injectable preparation.-   20. A ligand (eg, an antibody or fragment) for use in the method of    any one of clauses 1 to 19, wherein the ligand specifically binds    the PCSK9.-   21. A kit comprising the ligand of clause 20 and instructions for    carrying out the method of any one of clauses 1 to 19.

B: The invention further provides the following regimens, ligands andkits.

-   1. A method of reducing cholesterol level or maintaining a    previously reduced cholesterol level in a human in need thereof, the    method comprising:—    -   a. Carrying out an initial treatment of said human for an        initial treatment period by administering an anti-human PCSK9        ligand (eg, an antibody or fragment) to said human, wherein (i)        the ligand has been determined to specifically bind to a PCSK9        comprising a C-terminal domain comprising a said PCSK9 mutation        (eg, I474V or 670G) (numbering according to SEQ ID NO:1); (ii)        the human expresses said PCSK9 or the genome of the human        comprises a nucleotide sequence encoding said PCSK9 and (iii)        the human has received or is receiving statin treatment to lower        or maintain cholesterol level; wherein the initial treatment        comprises the administration of a single or multiple doses of        the ligand to the human;    -   b. Determining to (i) terminate statin treatment (ii) keep the        human off statin treatment; or (iii) reduce statin treatment        after said initial treatment period; and    -   c. Continuing to administer the ligand to said patient after        said time period has expired, thereby reducing cholesterol level        or maintaining a previously reduced cholesterol level in said        human.

In an embodiment, determination of said specific binding is by referenceto binding assay data, eg, as determined using SPR or ELISA.Determination may, for example, be by reference to information in aprinted publication, eg, with knowledge of data presented in the presentor another patent application or in a journal article. Once armed withsuch knowledge (eg, in the absence of further testing of binding), theskilled person is able—by direction of the present invention—to treat arelevant human whose genotype or phenotype matches the bindingspecificity of the ligand.

The antibody or fragment can be according to any configuration, example,embodiment, aspect, clause or paragraph herein.

A pharmaceutically-effective amount of said ligand is administered.

In an embodiment, the method comprises, before said administering,selecting a human comprising said nucleotide sequence encoding thePCSK9, wherein the human is said human recited in clause 1.

In an example, the initial treatment period is 7 days, 14 days, 21 days,28 days, a month, two months, three months, four months, five months,six months, seven months, eight months, nine months or a year.

-   2. The method of clause 1, wherein the human has or is suffering    from statin-associated memory loss or a statin-associated    neurodegenerative condition, or has or is at increased risk of    diabetes (eg, statin-associated diabetes).-   3. The method of clause 1 or 2, comprising, before said initial    treatment, the step of determining that the human has or is    suffering from statin-associated memory loss or a statin-associated    neurodegenerative condition, or has or is at increased risk of    diabetes (eg, statin-associated diabetes).-   4. The method of clause 2 or 3, comprising, after step (b) (eg,    during step (c)) determining that the memory loss or said    neurodegenerative condition has improved.-   5. The method of any one of clauses 1 to 4, wherein said human is    over 40 years of age (eg, 50 or over, 55 or over, 60 or over, 65 or    over, or 70 or over).-   6. The method of any one of clauses 1 to 5, wherein step (c)    comprises determining to increase the doses of said ligand to be    administered after said initial treatment period and administering    said increased doses to said human.-   7. The method of any one of clauses 1 to 6, wherein step (b)    comprises determining that the human is intolerant or refactory to    treatment by a statin.-   8. The method of any one of clauses 1 to 7, wherein the initial    treatment comprises the administration of a statin, fenofibrate (eg,    Tricor™ or Lofibra™) or ezetimibe to the human in addition to the    ligand.-   9. The method of any one of clauses 1 to 8, wherein step (b)    comprises terminating or reducing statin, fenofibrate (eg, Tricor™    or Lofibra™) or ezetimibe treatment during step (c).-   10. The method of any one of clauses 1 to 9, comprising increasing    (ie, increasing compared to the initial treatment dose) the ligand    dose during step (c).-   11. The method of any one of clauses 1 to 10, wherein the human has    received high dose statin treatment prior to the initial treatment,    and wherein step (c) comprises administering a lower (eg, a medium    or low) dose statin treatment in addition to said ligand.    -   The skilled person is familiar with the meaning of high, medium        and low dose treatments (and how to determine according to each        patient, eg, the patient's body mass). For example, the statin        is selected from rosuvastatin, atorvastatin and simvastatin.    -   For example daily statin doses are as follows:—Low 10 to 20 mg        (eg, 10 mg); medium >20 and <60 mg (eg, 40 mg); high 60-100 mg        (eg, 80 mg).-   12. The method of any one of clauses 1 to 10, wherein the human has    received medium dose statin treatment prior to the initial    treatment, and wherein step (c) comprises administering a lower (eg,    a low) dose statin treatment or no statin in addition to said    ligand.-   13. The method of any one of clauses 1 to 10, wherein the human has    received low dose statin treatment prior to the initial treatment,    and wherein step (c) comprises administering no statin in addition    to said ligand.-   14. The method of any one of clauses 1 to 13, comprising, before the    initial treatment, the step of determining that the ligand    specifically binds to said PCSK9, eg, using SPR or ELISA.-   15. The method of any one of clauses 1 to 14, wherein the specific    binding to said PCSK9 is binding with a dissociation constant (Kd)    of 1 nM or less, eg, 100, 10 or 1pM or less.-   16. The method of any of clauses 1 to 15, wherein the human is at    risk of or suffering from a condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   17. The method of clause 16, wherein step (c) treats or reduces the    risk of said condition in the human.-   18. The method of any one of clauses 1 to 17, wherein the human has    been determined to comprise the nucleotide sequence that encodes a    PCSK9 comprising a C-terminal domain comprising said mutation (eg,    I474V or E670G) in SEQ ID NO: 1 and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein encoded by the    nucleotide sequence of SEQ ID NO: 29 or 30.-   19. The method of any one of clauses 1 to 18, comprising the step of    determining that the human comprises the nucleotide sequence that    encodes a PCSK9 comprising a C-terminal domain comprising said    mutation (eg, I474V or E670G) and/or a proprotein convertase    subtilisin/kexin type 9 (PCSK9) variant protein comprising said    mutation (eg, I474V or E670G), optionally, wherein the determining    step is performed before administration of the antibody to the    human.-   20. The method of clause 19, wherein the step of determining    comprises assaying a biological sample from the human for a    nucleotide sequence encoding the PCSK9 that comprises the C-terminal    domain comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1.-   21. The method of clause 20, wherein the assaying comprises    contacting the biological sample with    -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        that specifically hybridizes to an antisense of said sequence,        wherein said nucleic acid hybridizes to at least one nucleotide        present in said selected sequence which is not present in SEQ ID        NO: 28 or hybridizes to an antisense sequence thereby forming a        complex when at least one nucleotide sequence encoding the PCSK9        that comprises the C-terminal domain comprising the mutation        (eg, I474V or E670G) in SEQ ID NO: 1 is present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        encoding the PCSK9 that comprises the C-terminal domain        comprising the mutation (eg, I474V or E670G) in SEQ ID NO: 1 or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises at        least one nucleotide present in said selected sequence which is        not present in SEQ ID NO: 28 thereby forming a complex when the        nucleotide sequence encoding the PCSK9 that comprises a        C-terminal domain comprising the mutation (eg, I474V or E670G)        in SEQ ID NO: 1 is present; and detecting the presence or        absence of the complex, wherein detecting the presence of the        complex determines that the human comprises the PCSK9 that        comprises the C-terminal domain comprising the mutation (eg,        I474V or E670G) in SEQ ID NO: 1.-   22. The method of clause 20 or 21, wherein the assaying comprises    nucleic acid amplification and optionally one or more methods    selected from sequencing, next generation sequencing, nucleic acid    hybridization, and allele-specific amplification and/or wherein the    assaying is performed in a multiplex format.-   23. The method of any one of clauses 1 to 22, wherein said human is    or has been further determined to be substantially resistant to    statin treatment.-   24. The method of any one of clauses 20 to 22, wherein said    biological sample comprises serum, blood, faeces, tissue, a cell,    urine and/or saliva of said human.-   25. The method of any one of clauses 1 to 24, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation (eg, I474V or    E670G), optionally, wherein said human is further indicated as    comprising the nucleotide sequence of SEQ ID NO: 28, or said human    is indicated as homozygous for a nucleotide sequence encoding the    PCSK9 C-terminal domain comprising said mutation I474V or E670G in    SEQ ID NO: 1.-   26. The method of any one of clauses 1 to 25, wherein said human has    been diagnosed with at least one condition selected from a lipid    disorder, hyperlipoproteinemia, hyperlipidemia, dyslipidemia,    hypercholesterolemia, a heart attack, a stroke, coronary heart    disease, atherosclerosis, peripheral vascular disease, claudication    (eg, claudication associated with elevated cholesterol) and high    blood pressure.-   27. The method of any one of clauses 1 to 26, wherein the nucleotide    sequence is SEQ ID NO: 29 or 30.-   28. The method of any one of clauses 1 to 27, wherein said ligand    (eg, antibody or antibody fragment) is administered by intravenous    or subcutaneous administration and/or is comprised in an injectable    preparation.-   29. A ligand (eg, an antibody or fragment) for use in the method of    any one of clauses 1 to 28, wherein the ligand specifically binds    the PCSK9.-   30. A kit comprising the ligand of clause 29 and instructions for    carrying out the method of any one of clauses 1 to 28.

In an example of any aspect of the invention, the ligand (eg, antibodyor fragment, eg, alirocumab, bocovizumab or evolocumab, or an antibodyor fragment comprising the variable domains of 316P or 31H4) isadministered to the human at a two-weekly dose of from 75 to 150 mg (eg,from 75 to 150 mg administered once or twice over a two-week period). Inan example, the ligand is for such administration to the human.

Determination of Specific Binding of Ligands of the Invention to PCSK9Variants

Method of SPR Determination of Binding

Binding of the antibodies to the PCSK9 variants was carried out by SPRusing the ProteOn XPR36™ Array system (BioRad). An anti-human IgGsurface (Jackson Labs 109-005-008) was created on a GLC Biosensor chipby primary amine coupling. Test antibodies were captured on this surfaceas ligands. The PCSK9 variants were used as analytes and passed over thecaptured antibodies at 256 nM, 64 nM, 16 nM, 4 nM and 1 nM. Bindingcurves were double referenced using a buffer injection (i.e. 0 nM) toremove baseline drift and injection artefacts. Regeneration of thecapture surface was with 100 mM phosphoric acid which removed thecaptured antibody allowing another cycle of capture and binding. Thebinding sensorgrams generated were analysed using the 1:1 model inherentto the ProteOn XPR36 Array system analysis software. The assay wasperformed at 25° C. and using 1×HBS-EP (Teknova) as running buffer.

Data

Three antibodies were tested and the resulting binding data arepresented below (Table 3). Antibodies 316P and 31H4 are antibodiesdisclosed in US20110065902A1 (the sequences of these antibodies andtheir variable domains are incorporated herein by reference for possibleuse in the present invention and possible inclusion in claims herein).Antibody 316P comprises heavy chain variable domains derived fromrecombination of human VH3-23*04 and JH2*01 (with a D), and light chainvariable domains derived from recombination of human Vκ4-1*01 andJκ2*01.

Evolocumab comprises a human IGHG2*01 heavy chain and a human IGLC2*01lambda light chain, a VH derived from recombination of human IGHV1-18*01and IGHJ6*01 (with a D segment) and a Vλ derived from recombination ofhuman IGLV2-14*01 and IGLJ2*01.

SPR Determination of Ligand Binding Specificity for PCSK9 VariantsVariant/Antibody ka (1/Ms) kd (1/s) KD (nM) PCSK9 a 316P 1.37E+062.75E−04 0.201 31H4 1.14E+06 6.38E−05 0.056 Evolocumab 1.14E+05 2.62E−050.229 PCSK9 a' 316P 1.50E+06 2.72E−04 0.181 31H4 1.23E+06 6.06E−05 0.049Evolocumab 1.24E+05 2.29E−05 0.185 PCSK9 c 316P 1.49E+06 2.75E−04 0.18431H4 1.22E+06 5.69E−05 0.047 Evolocumab 1.20E+05 2.20E−05 0.183 PCSK9 r316P 1.40E+06 2.76E−04 0.197 31H4 1.15E+06 5.82E−05 0.051 Evolocumab1.16E+05 2.67E−05 0.230 PCSK9 f 316P 1.39E+06 2.82E−04 0.203 31H41.13E+06 5.95E−05 0.053 Evolocumab 1.16E+05 2.66E−05 0.229 PCSK9 p 316P1.39E+06 2.73E−04 0.196 31H4 1.14E+06 6.12E−05 0.054 Evolocumab 1.14E+052.50E−05 0.219

Results

The results showed that all antibodies tested bound to PCSK9 variantsequally, with any binding variation seen being within experimental errorfor such a strong affinity interaction.

Thus, the invention determines that an antibody with the followingprofile can specifically bind one or more variants of the invention:—

1. An antibody (eg, 316P or alirocumab) that comprises heavy chainvariable domains derived from recombination of human IGHV3-23*04 andIGHJH2*01 (with a D), and light chain variable domains derived fromrecombination of human IGKV4-1*01 and IGKJ2*01; or

2. An antibody (eg, evolocumab) that comprises human heavy chainvariable domains derived from recombination of human IGHV1-18*01 andIGHJ6*01 (with a D segment) and light chain variable domains derivedfrom recombination of human IGLV2-14*01 and IGLJ2*01.

Thus, according to the invention, the skilled person is hereby providedwith the required determination of specific binding of the ligand toPCSK9 variants. Applications of this determination are set out above inthe context of methods and other aspects of the invention.

REFERENCES

-   Horton et al, Trends Biochem Sci. 2007 February; 32(2):71-7. Epub    2007 Jan. 9, Molecular biology of PCSK9: its role in LDL metabolism.-   Seidah and Prat, J Mol Med (Berl). 2007 July; 85(7):685-96. Epub    2007 Mar. 10, The proprotein convertases are potential targets in    the treatment of dyslipidemia.-   Benjannet et al, J Biol Chem. 2004 Nov. 19; 279(47):48865-75. Epub    2004 Sep. 9, NARC-1/PCSK9 and its natural mutants: zymogen cleavage    and effects on the low density lipoprotein (LDL) receptor and LDL    cholesterol.-   Lagace et al, J Clin Invest. 2006 November; 116(11):2995-3005,    Secreted PCSK9 decreases the number of LDL receptors in hepatocytes    and in livers of parabiotic mice.-   Maxwell et al, Proc Natl Acad Sci USA. 2005 Feb. 8; 102(6):2069-74.    Epub 2005 Jan. 27, Overexpression of PCSK9 accelerates the    degradation of the LDLR in a post-endoplasmic reticulum compartment.-   Park et al, J Biol Chem. 2004 Nov. 26; 279(48):50630-8. Epub 2004    Sep. 22, Post-transcriptional regulation of low density lipoprotein    receptor protein by proprotein convertase subtilisin/kexin type 9a    in mouse liver.-   Rashid et al, Proc Natl Acad Sci USA. 2005 Apr. 12; 102(15):5374-9.    Epub 2005 Apr. 1, Decreased plasma cholesterol and hypersensitivity    to statins in mice lacking Pcsk9.-   Kotowski et al, Am J Hum Genet. 2006 March; 78(3):410-22. Epub 2006    Jan. 20, A spectrum of PCSK9 alleles contributes to plasma levels of    low-density lipoprotein cholesterol.-   Chen et al, J Am Coll Cardiol. 2005 May 17; 45(10):1611-9. Epub 2005    Apr. 21, A common PCSK9 haplotype, encompassing the E670G coding    single nucleotide polymorphism, is a novel genetic marker for plasma    low-density lipoprotein cholesterol levels and severity of coronary    atherosclerosis.-   Pisciotta et al, Atherosclerosis. 2006 June; 186(2):433-40. Epub    2005 Sep. 23, Additive effect of mutations in LDLR and PCSK9 genes    on the phenotype of familial hypercholesterolemia.-   Zhao et al, Am J Hum Genet. 2006 September; 79(3):514-23. Epub 2006    Jul. 18, Molecular characterization of loss-of-function mutations in    PCSK9 and identification of a compound heterozygote.-   Seidah et al, Proc Natl Acad Sci USA. 2003 Feb. 4; 100(3):928-33.    Epub 2003 Jan. 27, The secretory proprotein convertase neural    apoptosis-regulated convertase 1 (NARC-1): liver regeneration and    neuronal differentiation.

Example 2 IL4 Receptor Alpha (IL4Ra; CD124)

Interleukin-4 (IL-4, also known as B cell stimulating factor or BSF-1)was originally characterized by its ability to stimulate theproliferation of B cells in response to low concentrations of antibodiesdirected to surface immunoglobulin. IL-4 has been shown to possess abroad spectrum of biological activities, including growth stimulation ofT cells, mast cells, granulocytes, megakaryocytes and erythrocytes. IL-4induces the expression of class II major histocompatibility complexmolecules in resting B cells, and enhances the secretion of IgE and IgGIisotypes by stimulated B cells

In an example, the invention provides a method of treating or reducingthe risk of an IL4Ra-mediated disease or condition in a human in needthereof, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human IL4RAprotein. The invention also provides a corresponding ligand.

The present invention provides anti-IL4Ra ligands; and IL4Ra-binding ortargeting ligands as described herein. The ligands have a variety ofutilities. Some of the ligands, for instance, are useful in specificbinding assays, for genotyping or phenotyping humans, affinitypurification of IL4Ra, in particular human IL4Ra or its ligands and inscreening assays to identify other antagonists of IL4Ra activity. Someof the ligands of the invention are useful for inhibiting binding ofIL4Ra to IL4, or inhibiting IL4Ra-mediated activities.

Anti-IL4Ra ligands (eg, antibodies and anti-sense RNA) have beendeveloped based on targeting and neutralising so-called “wild-type”human IL4Ra, which is a commonly-occurring form (see, eg, SEQ ID NO:67). While such therapies are useful for human patients harbouring thisform of human IL4RA, the inventor considered it useful to investigatethe possibility of targeting rarer—but still naturally-occurring—formsof IL4Ra amongst human populations. In this way, the inventor arrived atinsight into the natural occurrences and distributions of rarer humanIL4Ra forms that can serve as useful targets (at the protein or nucleicacid level) for human treatment, prophylaxis and diagnosis pertinent todiseases and conditions mediated or associated with IL4RA activity. Thisparticularly provides for tailored therapies, prophylaxis and diagnosisin humans that are devoid of the common IL4Ra gene or protein.

The skilled person will know that SNPs or other changes that translateinto amino acid variation can cause variability in activity and/orconformation of human targets to be addressed. This has spawned greatinterest in personalized medicine where genotyping and knowledge ofprotein and nucleotide variability is used to more effectively tailormedicines and diagnosis of patients. The invention, therefore, providesfor tailored pharmaceuticals and testing that specifically addressesrarer IL4Ra polymorphic variant forms. Such forms or “alleles” (at thenucleotide level), comprise one or more changes at the nucleotide andamino acid levels from the corresponding common form nucleotide andamino acids sequences, ie, there are one or more non-synonymous changesat the nucleotide level that translate into one or more correspondingchanges in the protein target in humans.

Furthermore, the inventor surprisingly realised that the rarer naturalforms, although present in humans at much lower frequencies than thecommon form, nevertheless are represented in multiple andethnically-diverse human populations and usually with many humanexamples per represented ethnic population. Thus, the inventor realisedthat targeting such rarer forms would provide for effective treatment,prophylaxis or diagnosis across many human ethnic populations, therebyextending the utility of the present invention.

With this realisation, the inventor realised that there is significantindustrial and medical application for the invention in terms of guidingthe choice of anti-IL4Ra ligand for administration to human patients fortherapy and/or prophylaxis of IL4Ra-mediated or associated diseases orconditions. In this way, the patient receives drugs and ligands that aretailored to their needs—as determined by the patient's genetic orphenotypic makeup. Hand-in-hand with this, the invention provides forthe genotyping and/or phenotyping of patients in connection with suchtreatment, thereby allowing a proper match of drug to patient. Thisincreases the chances of medical efficacy, reduces the likelihood ofinferior treatment using drugs or ligands that are not matched to thepatient (eg, poor efficacy and/or side-effects) and avoidspharmaceutical mis-prescription and waste.

In developing this thinking, in this non-limiting example the presentinventor decided to determine a set of human IL4Ra variants on the basisof the following criteria, these being criteria that the inventorrealised would provide for useful medical drugs and diagnostics totailored need in the human population. The inventor selected variantshaving at least 3 of the 4 following criteria:—

Naturally-occurring human IL4Ra variation having a cumulative humanallele frequency of 35% or less;

Naturally-occurring human IL4Ra variation having a total human genotypefrequency of about 50% or less;

Naturally-occurring human IL4Ra variation found in many different humanethnic populations (using the standard categorisation of the 1000Genomes Project; see Table 2 below); and

Naturally-occurring human IL4Ra variation found in many individualsdistributed across such many different ethnic populations.

On the basis of these criteria, the inventor identified variants listedin Table 11 below. The inventor's selection included, as an additionalor alternative consideration, selection for nucleotide variation thatproduced amino acid variation in corresponding IL4Ra forms (ie,non-synonymous variations), as opposed to silent variations that do notalter amino acid residues in the target protein.

In an example, the invention provides a method of treating or reducingthe risk of an IL4Ra-mediated disease or condition in a human in needthereof, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human IL4RAprotein that comprises a mutation selected from the group consisting ofI75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67. Asexplained further below, these amino acid variations are found innaturally-occurring IL-4Ra variants in humans found in many populations.Said human comprises a nucleotide sequence encoding said IL4RA proteincomprising said mutation selected from the group consisting of I75V,E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67.

An example also provides a ligand (eg, an antibody or antibody fragment)for treating or reducing the risk of an IL4Ra-mediated disease orcondition in a human in need thereof, the method comprisingadministering to said human said ligand, wherein the ligand specificallybinds a human IL4RA protein that comprises a mutation selected from thegroup consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ IDNO: 67. Said human comprises a nucleotide sequence encoding said IL4RAprotein comprising said mutation selected from the group consisting ofI75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67.

In an example, the invention provides a method of targeting IL4Ra in ahuman, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human IL4RAprotein that comprises a mutation selected from the group consisting ofI75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67. Said humancomprises a nucleotide sequence encoding said IL4RA protein comprisingsaid mutation selected from the group consisting of I75V, E400A, C431R,S503P, Q576R and S752A in SEQ ID NO: 67. In an example, the human issuffering from or at risk of an IL4Ra-mediated disease or condition. Inan example, the method treats or reduces the risk of an IL4Ra-mediateddisease or condition in the human.

An example also provides a ligand (eg, an antibody or antibody fragment)for targeting IL4Ra in a human, the method comprising administering tosaid human said ligand, wherein the ligand specifically binds a humanIL4RA protein that comprises a mutation selected from the groupconsisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO:67. Said human comprises a nucleotide sequence encoding said IL4RAprotein comprising said mutation selected from the group consisting ofI75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67. In anexample, the human is suffering from or at risk of an IL4Ra-mediateddisease or condition. In an example, the method treats or reduces therisk of an IL4Ra-mediated disease or condition in the human.

In an embodiment, (i) the antibody or fragment comprises a VH domainderived from the recombination of a human VH segment, a human D genesegment and a human JH segment, the human VH segment encoding theframework 1 of SEQ ID NO: 40 and wherein said human comprises a VH genesegment encoding the framework 1 of SEQ ID NO: 40, or the humanexpresses VH domains that comprise the framework 1 of SEQ ID NO: 40; andwherein (ii) said human comprises a nucleotide sequence encoding saidIL4RA protein comprising said mutation selected from the groupconsisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO:67.

Additionally or alternatively, in an embodiment, (i) the antibody orfragment comprises a human gamma-4 heavy chain constant region thatcomprises a Leu at position 189 shown in SEQ ID NO: 73 or an Arg atposition 289 shown in SEQ ID NO: 73 and wherein said human comprises anIGHG4*01 human heavy chain constant region gene segment, or the humanexpresses antibodies comprising human gamma-4 heavy chain constantregions comprising a Leu at position 189 shown in SEQ ID NO: 73 or anArg at position 289 shown in SEQ ID NO: 73; and wherein (ii) said humancomprises a nucleotide sequence encoding said IL4RA protein comprisingsaid mutation selected from the group consisting of I75V, E400A, C431R,S503P, Q576R and S752A in SEQ ID NO: 67.

The biological activities of IL-4 are mediated by specific cell surfacereceptors for IL-4. Human IL-4 receptor alpha (h1L-4Ra) is described in,for example, U.S. Pat. Nos. 5,599,905, 5,767,065, and 5,840,869.Antibodies to h1L-4R are described in U.S. Pat. No. 5,717,072.

Methods for using antibodies to h1L-4R are described in U.S. Pat. Nos.5,714,146; 5,985,280; and 6,716,587.

The human IL-4Ra (aka IL-4Ra) subunit (Swiss Prot accession numberP24394) is a 140 kDa type 1 membrane protein that binds human IL-4 witha high affinity (Andrews et al J. Biol. Chem (2002) 277:46073-46078).The IL-4/IL-4Ra complex can dimerize with either the common gamma chain(yc, CD132) or the IL-13Ralpha1 (IL-13Ra1) subunit, via domains on IL-4,to create two different signalling complexes, commonly referred to asType I and Type II receptors, respectively. Alternatively, IL-13 canbind IL-13Ra1 to form an IL-13/IL-13Ra1 complex that recruits the IL-4Rasubunit to form a Type II receptor complex. Thus, IL-4Ra mediates thebiological activities of both IL-4 and IL-13 (reviewed by Gessner et al,Immunobiology, 201:285, 2000). In vitro studies have shown that IL-4 andIL-13 activate effector functions in a number of cell types, for examplein T cells, B cells, eosinophils, mast cells, basophils, airway smoothmuscle cells, respiratory epithelial cells, lung fibroblasts, andendothelial cells (reviewed by Steinke et al, Resp Res, 2:66, 2001, andby Willis-Karp, Immunol Rev, 202:175, 2004).

IL-4 by binding to its receptor (IL-4R) is essential for the developmentof airway inflammation present in asthma, through the induction of IgEsynthesis in B cells and differentiation of T cells to a Th2 phenotype.Dupilumab is a monoclonal antibody designed for the treatment of atopicdiseases. It binds to the alpha subunit of the interleukin-4 receptor.Through blockade of IL-4R alpha, dupilumab modulates signaling of boththe IL-4 and IL-13 pathway, which have been implicated in thepathophysiology of allergic disease. Anti-IL4Ra ligands, antibodies andfragments according to the invention can, for example, be used fortreating or reducing the risk of allergic disease.

In an example, the ligand, antibody or fragment is for treating orreducing the risk of (or treats or reduces the risk of) allergic asthma,eosinophilic asthma or atopic dermatitis, optionally wherein theantibody is dupilumab.

In addition to its role in asthma, IL-4Ra has been linked with a numberof other pathologies, e.g. as follows (anti-IL4Ra ligands, antibodiesand fragments according to the invention can, for example, be used fortreating or reducing the risk of any one of these diseases orconditions):

Chronic Obstructive Pulmonary Disease (COPD) includes patientpopulations with varying degrees of chronic bronchitis, small airwaydisease and emphysema and is characterised by progressive irreversiblelung function decline that responds poorly to current asthma basedtherapy. The underlying causes of COPD remain poorly understood. The“Dutch hypothesis” proposes that there is a common susceptibility toCOPD and asthma and therefore, that similar mechanisms may contribute tothe pathogenesis of both disorders (Sluiter et al., Eur Respir J,).Zheng et al (J Clin Invest, 106(9):1081-93, 2000) have demonstrated thatoverexpression oflL-13 in the mouse lung caused emphysema, elevatedmucus production and inflammation, reflecting aspects of human COPD.Furthermore, AHR, an IL-13 dependent response in murine models ofallergic inflammation, has been shown to be predictive of lung functiondecline in smokers (Tashkin et al., Am J Respir Crit Care Med, 153(6 Pt1):1802-11, 1996). A link has also been established between an IL-13promoter polymorphism and susceptibility to develop COPD (Van Der PouwKraan et al., Genes Immun, 3(7): 436-9, 2002). The signs are thereforethat IL-4/IL-13 pathway, and in particular IL-13, plays an importantrole in the pathogenesis of COPD.

In addition to asthma, the IL-4/11-13 pathway has been linked to otherfibrotic conditions, like systemic sclerosis (Hasegawa et al., JRheumatol, 24(2):328-32, 1997), pulmonary fibrosis (Hancock et al., Am JRespir Cell Mol Biol, 18(1): 60-5, 1998), parasite-induced liverfibrosis (Fallon et al., J Immunol, 164(5): 2585-91, 2000; Chiaramonteet al., J Clin Invest, 104(6): 777-85, 1999; Chiaramonte Hepatology34(2):273-82, 2001), and cystic fibrosis (Hauber et al. J. Cyst Fibr,2:189, 2003).

IL-4 and to some extent IL-13, are crucial for B cell mediatedactivities, such as B cell proliferation, immunoglobulin secretion, andexpression of FcepsilonR. Clinical applications of an IL-4Ra inhibitorinclude for example, use in allergy therapy to suppress IgE synthesis(including for example atopic dermatitis and food allergy), use intransplation therapy to prevent transplant rejection, as well assuppression of delayed-type hypersensitivity or contact hypersensitivityreactions.

Il-4R antagonists may also find use as adjuvants to allergyimmunotherapy and as vaccine adjuvants.

IL-4Ra polymorphisms in the human population have been described(reviewed by Gessner et al, Immunobiology, 201:285, 2000) andassociation with IgE levels or clinical atopy has been reported in somepopulations. For instance, V75R576 IL-4Ra is associated with allergicasthma and enhanced IL-4Ra function (Risma et al. J. Immunol.169(3):1604-1610, 2002).

Anti-IL4Ra ligands, antibodies and fragments according to the inventionoptionally neutralise IL-4Ra with high potency, for example as describedin more detail in the Examples of EP2604628. Neutralisation meansinhibition of a biological activity mediated by IL-4Ra. Ligands,antibodies and fragments according to the invention may neutralise oneor more activities mediated by IL-4Ra. The inhibited biological activityis likely mediated by prevention of IL-4Ra forming a signalling complexwith gamma chain (or IL-13Ra) and either of the associated solubleligands, e.g. IL-4 or IL-13.

Neutralisation of IL-4 or IL-13 signalling through its IL-4Ra containingreceptor complex may be measured by inhibition of IL-4 or IL-13stimulated TF-1 cell proliferation.

The ligand, antibody or fragment according to the invention is, forexample, dupilumab or any one disclosed in WO 08/054606 (Regeneron),EP2604628 (Medimmune), WO 01/92340 (immnunex) or WO 05/047331 (Immunex),the disclosures of which (including the sequences, eg, VH, VL and heavyand light chain sequences) are incorporated herein by reference forpotential inclusion in one or more claims herein. According to a furtheraspect of the ligand, antibody or fragment according to the invention iscapable of binding human interleukin-4 receptor alpha (hIL-4Ra) andcynomolgus monkey interleukin-4 receptor alpha (cyIL-4Ra). CynomolgusIL-4Ra cDNA sequence is shown as SEQ ID NO: 455 EP2604628. In aparticular embodiment the antibody or fragment is a human antibody orfragment. The ligand, antibody or fragment according to the invention isan antibody or fragment, for example, that comprises a VH and/or VL ofdupilumab, or comprises a heavy and/or light chain of dupilumab. In oneembodiment, the ligand, antibody or fragment comprises a VH domaincomprising SEQ ID NO: 69. In one embodiment, the ligand, antibody orfragment comprises a VL domain comprising SEQ ID NO: 70. In oneembodiment, the ligand, antibody or fragment comprises a heavy chaincomprising SEQ ID NO: 71. In one embodiment, the ligand, antibody orfragment comprises a light chain comprising SEQ ID NO: 72.

In a specific embodiment, the ligand, antibody or fragment of presentinvention comprises an Fc region, wherein the Fc region comprises atleast one non-native amino acid residue selected from the groupconsisting of 234D, 234E, 234N, 234Q, 234T, 234H, 234Y, 2341, 234V,234F, 235A, 235D, 235R, 235W, 235P, 235S, 235N, 235Q, 235T, 235H, 235Y,235I, 235V, 235F, 236E, 239D, 239E, 239N, 239Q, 239F, 239T, 239H, 239Y,240I, 240A, 240T, 240M, 241W, 241 L, 241Y, 241E, 241R. 243W, 243L 243Y,243R, 243Q, 244H, 245A, 247L, 247V, 247G, 251F, 252Y, 254T, 255L, 256E,256M, 262I, 262A, 262T, 262E, 263I, 263A, 263T, 263M, 264L, 264I, 264W,264T, 264R, 264F, 264M, 264Y, 264E, 265G, 265N, 265Q, 265Y, 265F, 265V,265I, 265L, 265H, 265T, 266I, 266A, 266T, 266M, 267Q, 267L, 268E, 269H,269Y, 269F, 269R, 270E, 280A, 284M, 292P, 292L, 296E, 296Q, 296D, 296N,296S, 296T, 296L, 296I, 296H, 269G, 297S, 297D, 297E, 298H, 298I, 298T,298F, 299I, 299L, 299A, 299S, 299V, 299H, 299F, 299E, 305I, 313F, 316D,325Q, 325L, 325I, 325D, 325E, 325A, 325T, 325V, 325H, 327G, 327W, 327N,327L, 328S, 328M, 328D, 328E, 328N, 328Q, 328F, 328I, 328V, 328T, 328H,328A, 329F, 329H, 329Q, 330K, 330G, 330T, 330C, 330L, 330Y, 330V, 330I,330F, 330R, 330H, 331G, 331A, 331L, 331M, 331F, 331W, 331K, 331Q, 331E,331S, 331V, 331I, 331C, 331Y, 331H, 331R, 331N, 331D, 331T, 332D, 332S,332W, 332F, 332E, 332N, 332Q, 332T, 332H, 332Y, 332A, 339T, 370E, 370N,378D, 392T, 396L, 416G, 419H, 421K, 440Y and 434W as numbered by the EUindex as set forth in Kabat. Optionally, the Fc region may compriseadditional and/or alternative non-native amino acid residues known toone skilled in the art (see, e.g., U.S. Pat. Nos. 5,624,821; 6,277,375;6,737,056; PCT Patent Publications WO 01/58957; WO 02/06919; WO04/016750; WO 04/029207; WO 04/035752 and WO 05/040217).

The ligand, antibody or fragment according to the invention is fortreating or preventing or reducing the risk of (or treats or prevents orreduces the risk of), for example, any disease or condition disclosed inany of WO 08/054606 (Regeneron), EP2604628 (Medimmune), WO 01/92340(immnunex) and WO 05/047331 (Immunex), the disclosures of which diseasesand conditions are incorporated herein by reference for potentialinclusion in one or more claims herein.

Further encompassed by the invention is the use of the ligand, antibodyor fragment of an in the manufacture of a medicament for use toattenuate or inhibit an IL-4Ra-mediated disease or disorder in a human.IL-4Ra-mediated or related disorders which are treated by the ligand,antibody or fragment of the invention include, for example, arthritis(including septic arthritis), herpetiformis, chronic idiopathicurticaria, scleroderma, hypertrophic scarring, Whipple's Disease, benignprostate hyperplasia, lung disorders, such as mild, moderate or severeasthma, inflammatory disorders such as inflammatory bowel disease,allergic reactions, Kawasaki disease, sickle cell disease, Churg-Strausssyndrome, Grave's disease, pre-eclampsia, Sjogren's syndrome, autoimmunelymphoproliferative syndrome, autoimmune hemolytic anemia, Barrett'sesophagus, autoimmune uveitis, tuberculosis, and nephrosis.

Particular conditions for which a ligand, antibody or fragment of theinvention may be used in treatment or diagnosis include: asthma, COPD(eg, chronic bronchitis, small airway disease or emphysema),inflammatory bowel disease, a fibrotic condition (eg, systemicsclerosis, pulmonary fibrosis, parasite-induced liver fibrosis, orcystic fibrosis), allergy (for example atopic dermatitis, dust miteallergy, pet allergy or food allergy), transplation therapy to preventtransplant rejection, suppression of a delayed-type hypersensitivity ora contact hypersensitivity reaction, as an adjuvant to allergyimmunotherapy or as a vaccine adjuvant. In an example, the method andligand are for treating or preventing (or reducing the risk of) nasalypolyps and/or sinusitis.

Thus, a ligand, antibody or fragment of the invention is useful as atherapeutic agent in the treatment of a condition involving IL-4, IL-13or IL-4Ra expression and/or activity. One embodiment, among others, is amethod of treatment comprising administering an effective amount of aligand, antibody or fragment of the invention to a patient in needthereof, wherein functional consequences of IL-4Ra activation aredecreased. Another embodiment, among others, is a method of treatmentcomprising (i) identifying a patient demonstrating IL-4, IL-13 or IL-4Raexpression or activity, and (ii) administering an effective amount of aligand, antibody or fragment of the invention to the patient, wherein afunctional consequence of IL-4Ra activation are attenuated. An effectiveamount according to the invention is an amount that modulates (e.g.decreases) the functional consequences of IL-4Ra activation so as tomodulate (e.g. decrease or lessen) the severity of at least one symptomof the particular disease or disorder being treated, but not necessarilycure the disease or disorder. Accordingly, one embodiment of theinvention is a method of treating or reducing the severity of at leastone symptom of any of the disorders referred to herein, comprisingadministering to a patient in need thereof an effective amount of one ormore ligands, antibodies or fragments of the present invention alone orin a combined therapeutic regimen with another appropriate medicamentknown in the art or described herein such that the severity of at leastone symptom of any of the disorders is reduced. Another embodiment ofthe invention, among others, is a method of antagonizing at least oneeffect of IL-4Ra comprising contacting with or administering aneffective amount of one or more ligands, antibodies or fragments of thepresent invention such that said at least one effect of IL-4Ra isantagonized, e.g. the ability of IL-4Ra to form a complex (the precursorto active signalling) with IL-4.

A ligand, antibody or fragment of the invention can, in an example, beused in combination with another therapeutic agent for the treatment ofcancer. Suitable agents to be used in combination include thosedisclosed in EP2604628 (eg, in paragraph [0287]), which disclosure isincorporated herein by reference.

Tailoring Antibodies to Rarer IL4Ra Variant Profile

As outlined herein (for example, in the context of PCSK9 in Example 1),the invention includes the possibility to tailor treatment of humansfurther by selecting antibody-based ligands with variable domains and/orconstant domains based on gene segments found in many humans of theethnic populations where the variant TOI forms are found to meet theselection criteria of the invention. This also applies mutatis mutandiswhere the TOI is human IL4Ra, as in the present example. Thus, alldisclosure herein relating to tailoring variable and/or constant domainsapply to the present example, relating to IL4Ra and is combinable foruse in one or more claims herein.

As described in Example 1, an example is provided for ligands comprisingantibody VH domains derived from recombination of human IGHV genesegments comprising selected nucleotides at positions in the HCDR1 orFW3 where there is variability in humans (ie, where SNPs occur inhumans).

Further information is provided in Table 4, which shows variation atthese positions, as well as the variant distributions across the 1000Genomes Project database relating to many human populations.

In other embodiments, as explained more fully above, the inventionprovides for ligands which are tailored to the human recipient'sgenotype and/or phenotype based on alternative human VH gene segments,or on Vκ, Vλ or constant region gene segments (see further Table 9 forrepresentative variants).

In an example, following this guidance, the chosen ligand is dupilumab.

Further examples, therefore are:—

(i) wherein the ligand comprises a VH domain derived from therecombination of a human VH segment (eg, human VH3-23*04), a human Dgene segment and a human JH segment, the human VH segment encoding theframework 1 of SEQ ID NO: 40 and wherein said human comprises a VH genesegment encoding the framework 1 of SEQ ID NO: 40, or the humanexpresses VH domains that comprise the framework 1 of SEQ ID NO: 40.(ii) wherein the ligand comprises a VH domain derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment, and wherein said human comprises a IGHV3-7*01 VHgene segment or the human expresses VH domains derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment.(iii) wherein the ligand comprises a Vκ domain derived from therecombination of human Vκ segment IGKV1-12*01 and a human Jκ segment,and wherein said human comprises a IGKV1-12*01 Vκ gene segment or thehuman expresses Vκ domains derived from the recombination of human Vκsegment IGKV1-12*01 and a human Jκ segment.(iv) wherein the ligand comprises a Vκ domain derived from therecombination of a human Vκ segment and a human Jκ segment, the human Vκsegment encoding (i) a CDR3 comprising a Pro at position 7 shown in SEQID NO: 36 and wherein said human comprises a Vκ gene segment encoding aCDR3 comprising a Pro at position 7 shown in SEQ ID NO: 36, or the humanexpresses Vκ domains that comprise a CDR3 comprising a Pro at position 7shown in SEQ ID NO: 36; or (ii) a FW3 comprising a Ser at position 15shown in SEQ ID NO: 38 and wherein said human comprises a Vκ genesegment encoding a FW3 comprising a Ser at position 15 shown in SEQ IDNO: 38 or the human expresses Vκ domains that comprise a FW3 comprisinga Ser at position 15 shown in SEQ ID NO: 38.(v) wherein the ligand comprises a human gamma-1 heavy chain constantregion that comprises an Asp at position 204 shown in SEQ ID NO: 4 or aLeu at position 206 shown in SEQ ID NO: 4 and wherein said humancomprises (i) an IGHG1*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-1heavy chain constant regions comprising an Asp at position 204 shown inSEQ ID NO: 4 or a Leu at position 206 shown in SEQ ID NO: 4.(vi) wherein the ligand comprises a human gamma-2 heavy chain constantregion that comprises an amino acid selected from the group consistingof a Pro at position 72 shown in SEQ ID NO: 6, an Asn at position 75shown in SEQ ID NO: 6, a Phe at position 76 shown in SEQ ID NO: 6, a Valat position 161 shown in SEQ ID NO: 6 and an Ala at position 257 shownin SEQ ID NO: 6 and wherein said human comprises (i) an IGHG2*01 humanheavy chain constant region gene segment, or the human expressesantibodies comprising human gamma-2 heavy chain constant regionscomprising said selected Pro at position 72 shown in SEQ ID NO: 6, Asnat position 75 shown in SEQ ID NO: 6, Phe at position 76 shown in SEQ IDNO: 6, Val at position 161 shown in SEQ ID NO: 6 or Ala at position 257shown in SEQ ID NO: 6.(vii) wherein the ligand comprises a human kappa chain constant regionthat comprises a Val at position 84 shown in SEQ ID NO: 16 or a Cys atposition 87 shown in SEQ ID NO: 16 and wherein said human comprises (i)an IGKC1*01 human kappa chain constant region gene segment, or the humanexpresses antibodies comprising human kappa chain constant regionscomprising a Val corresponding to position 84 shown in SEQ ID NO: 16 ora Cys at position 87 shown in SEQ ID NO: 16.(viii) wherein the ligand comprises a human IGLC1*01 lambda chainconstant region and wherein said human comprises (i) a human IGLC1*01lambda chain constant region gene segment, or the human expressesantibodies comprising human IGLC1*01 lambda chain constant regions.(ix) wherein the ligand comprises a human gamma-4 heavy chain constantregion that comprises a Leu at position 189 shown in SEQ ID NO: 73 or anArg at position 289 shown in SEQ ID NO: 73 and wherein said humancomprises (i) an IGHG4*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-4heavy chain constant regions comprising a Leu at position 189 shown inSEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73.

For example, as per example (ix), the inventor identified thepossibility of addressing IGH-gamma-4 variation and identified utilityfor variations 189L and 289R individually or in combination, since theseresidues are part of the CH3 domain, and as such they form part ofantibody Fc regions. Thus, matching of these CH3 variations with thepatient is especially beneficial for reasons as discussed above. Thus,in this example the ligand of the invention comprises or consists of anantibody that comprises a human gamma-4 heavy chain constant region thatcomprises a Leu corresponding to position 189 of SEQ ID NO: 73 or an Argcorresponding to position 289 of SEQ ID NO: 73 and wherein the genome ofthe human comprises a gamma-4 heavy chain constant region nucleotidesequence that encodes such a Leu and/or Arg or the human expressesantibodies comprising human gamma-4 constant regions comprising such aLeu and/or Arg. An example of such a ligand is dupilumab.

Determination of Specific Binding of Ligands of the Invention to IL4RAVariants

The specific binding of Ligands of the invention to IL4Ra variants canbe performed using the SPR method described in Example 1.

Embodiments are provided as follows:—

Methods with VH Tailoring

-   1. A method of treating or reducing the risk of an IL4Ra-mediated    disease or condition in a human in need thereof, the method    comprising administering to said human a ligand (eg, an antibody or    antibody fragment) that specifically binds a human IL4Ra protein    that comprises a mutation selected from the group consisting of    I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67;    -   wherein (i) the ligand comprises a VH domain derived from the        recombination of a human VH segment, a human D gene segment and        a human JH segment, the human VH segment encoding the framework        1 of SEQ ID NO: 40 and wherein said human comprises a VH gene        segment encoding the framework 1 of SEQ ID NO: 40, or the human        expresses VH domains that comprise the framework 1 of SEQ ID NO:        40; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said IL4RA protein comprising said mutation selected from the        group consisting of I75V, E400A, C431R, S503P, Q576R and S752A        in SEQ ID NO: 67.    -   In an alternative, clause 1 provides:—    -   A method of targeting IL4Ra in a human, the method comprising        administering to said human a ligand (eg, an antibody or        antibody fragment) that specifically binds a human IL4Ra protein        that comprises a mutation selected from the group consisting of        I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67;    -   wherein (i) the ligand comprises a VH domain derived from the        recombination of a human VH segment, a human D gene segment and        a human JH segment, the human VH segment encoding the framework        1 of SEQ ID NO: 40 and wherein said human comprises a VH gene        segment encoding the framework 1 of SEQ ID NO: 40, or the human        expresses VH domains that comprise the framework 1 of SEQ ID NO:        40; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said IL4RA protein comprising said mutation selected from the        group consisting of I75V, E400A, C431R, S503P, Q576R and S752A        in SEQ ID NO: 67.    -   In an example, the human is suffering from or at risk of an        IL4Ra-mediated disease or condition.    -   In an example, the method treats or reduces the risk of an        IL4Ra-mediated disease or condition in the human. Optionally the        disease is asthma. Optionally the disease is atopic dermatitis.        Optionally the disease is nasal polyps and/or sinusitis.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation I75V.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation E400A.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation C431R.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation S503P.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation Q576R.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation S752A.-   2. The method of clause 1, wherein the IL4Ra comprises mutations    I75V and Q576R in SEQ ID NO: 67 and optionally the disease is    asthma. Optionally the disease is atopic dermatitis. Optionally the    disease is nasal polyps and/or sinusitis.    -   Q576R and I75V are associated with airway inflammation disease,        eg, asthma. For example, see Clin Exp Allergy. 2003 August;        33(8):1111-7, “Polymorphisms in the interleukin-4 and        interleukin-4 receptor alpha chain genes confer susceptibility        to asthma and atopy in a Caucasian population”, Beghe B et al        (referring to I75V instead as I50V); J Asthma. 2010 April;        47(3):238-44.doi: 10.3109/02770900903509099, “Association and        gene-gene interactions of eight common single-nucleotide        polymorphisms with pediatric asthma in middle china”, Wu X et        al; Clin Exp Allergy. 2004 October; 34(10):1570-5, “Haplotypes        of the interleukin-4 receptor alpha chain gene associate with        susceptibility to and severity of atopic asthma”, Hytonen A M et        al, all incorporated herein by reference.-   3. The method of clause 1 or 2, wherein the nucleotide sequence    of (ii) comprises nucleotide mutation −3223T (dB SNP numbering).    -   This variation is associated with airway inflammation disease,        eg, asthma.-   4. The method of any preceding clause, wherein each said human VH    gene segment comprises SEQ ID NO: 39.-   5. The method of any preceding clause, wherein the VH gene segment    comprised by said human is a germline VH gene segment.-   6. The method of any preceding clause comprising, before said    administering, selecting a human comprising said nucleotide sequence    of (ii), wherein the human is the human of clause 1.-   7. The method of any preceding clause, wherein the human has been    determined to comprise the nucleotide sequence that encodes an IL4Ra    protein comprising said mutation selected from the group consisting    of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67    and/or an IL4Ra protein comprising said mutation selected from the    group consisting of I75V, E400A, C431R, S503P, Q576R and S752A in    SEQ ID NO: 67.-   8. The method of any preceding clause, comprising the step of    determining that the human comprises (a) the nucleotide sequence    that encodes an IL4Ra protein comprising said mutation selected from    the group consisting of I75V, E400A, C431R, S503P, Q576R and S752A    in SEQ ID NO: 67 and/or (b) an IL4Ra protein comprising said    mutation said mutation selected from the group consisting of I75V,    E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67, optionally,    wherein the determining step is performed before administration of    the antibody to the human.-   9. The method of clause 8, wherein the step of determining comprises    assaying a biological sample from the human for a nucleotide    sequence encoding a IL4Ra protein comprising said mutation selected    from the group consisting of I75V, E400A, C431R, S503P, Q576R and    S752A in SEQ ID NO: 67.-   10. The method of clause 9, wherein the assaying comprises    -   contacting the biological sample with at least one        oligonucleotide probe comprising a sequence of at least 10        contiguous nucleotides of a nucleotide sequence encoding an        IL4Ra protein comprising said mutation selected from the group        consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ        ID NO: 67 or comprising an antisense sequence of said contiguous        nucleotides, wherein said sequence of contiguous nucleotides        comprises a nucleotide sequence encoding said mutation selected        from the group consisting of I75V, E400A, C431R, S503P, Q576R        and S752A in SEQ ID NO: 67, thereby forming a complex when at        least one nucleotide sequence encoding the IL4Ra protein        comprising said mutation selected from the group consisting of        I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67 is        present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the IL4Ra protein comprising said mutation selected        from the group consisting of I75V, E400A, C431R, S503P, Q576R        and S752A in SEQ ID NO: 67.-   11. The method of clause 9, wherein the assaying comprises nucleic    acid amplification and optionally one or more methods selected from    sequencing, next generation sequencing, nucleic acid hybridization,    and allele-specific amplification and/or wherein the assaying is    performed in a multiplex format.-   12. The method of clause 9 or 11, wherein said biological sample    comprises serum, blood, faeces, tissue, a cell, urine and/or saliva    of said human.-   13. The method of any preceding clause, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    IL4Ra protein comprising said mutation selected from the group    consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID    NO: 67, optionally, wherein said human is further indicated as    comprising the nucleotide sequence of SEQ ID NO: 68, or said human    is indicated as homozygous for a nucleotide sequence encoding the    IL4Ra protein comprising said mutation selected from the group    consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID    NO: 67.-   14. The method of any preceding clause, wherein said human is or has    been further determined to be substantially resistant to an asthma    treatment.-   15. The method of any preceding clause, wherein said human is    receiving or has received an asthma treatment or has reduced    responsiveness to an asthma treatment.-   16. The method of any preceding clause, wherein said disease or    condition is an inflammatory disease or condition; an atopic disease    or condition; a respiratory disease or condition; a disease or    condition associated with elevated IgE; or a disease or condition    associated with elevated IL-4 and/or IL-13 activity.-   17. The method of any preceding clause, wherein said disease or    condition is selected from the group consisting of an airway    inflammatory disease or condition, chronic obstructive pulmonary    disease, asthma, pneumonia, hypersensitivity pneumonitis, pulmonary    infiltrate with eosinophilia, environmental lung disease, pneumonia,    bronchiectasis, cystic fibrosis, interstitial lung disease, primary    pulmonary hypertension, pulmonary thromboembolism, disorders of the    pleura, disorders of the mediastinum, disorders of the diaphragm,    hypoventilation, hyperventilation, sleep apnea, acute respiratory    distress syndrome, mesothelioma, sarcoma, graft rejection, graft    versus host disease, lung cancer, allergic rhinitis, allergy,    asbestosis, aspergilloma, aspergillosis, bronchiectasis, chronic    bronchitis, emphysema, eosinophilic pneumonia, idiopathic pulmonary    fibrosis, invasive pneumococcal disease, influenza, nontuberculous    mycobacteria, pleural effusion, pneumoconiosis, pneumocytosis,    pneumonia, pulmonary actinomycosis, pulmonary alveolar proteinosis,    pulmonary anthrax, pulmonary edema, pulmonary embolus, pulmonary    inflammation, pulmonary histiocytosis X, pulmonary hypertension,    pulmonary nocardiosis, pulmonary tuberculosis, pulmonary    veno-occlusive disease, rheumatoid lung disease, sarcoidosis, and    Wegener's granulomatosis.-   18. The method of any preceding clause, wherein said human has been    diagnosed with at least one condition selected from the group    consisting of an airway inflammatory disease or condition, chronic    obstructive pulmonary disease, asthma, pneumonia, hypersensitivity    pneumonitis, pulmonary infiltrate with eosinophilia, environmental    lung disease, pneumonia, bronchiectasis, cystic fibrosis,    interstitial lung disease, primary pulmonary hypertension, pulmonary    thromboembolism, disorders of the pleura, disorders of the    mediastinum, disorders of the diaphragm, hypoventilation,    hyperventilation, sleep apnea, acute respiratory distress syndrome,    mesothelioma, sarcoma, graft rejection, graft versus host disease,    lung cancer, allergic rhinitis, allergy, asbestosis, aspergilloma,    aspergillosis, bronchiectasis, chronic bronchitis, emphysema,    eosinophilic pneumonia, idiopathic pulmonary fibrosis, invasive    pneumococcal disease, influenza, nontuberculous mycobacteria,    pleural effusion, pneumoconiosis, pneumocytosis, pneumonia,    pulmonary actinomycosis, pulmonary alveolar proteinosis, pulmonary    anthrax, pulmonary edema, pulmonary embolus, pulmonary inflammation,    pulmonary histiocytosis X, pulmonary hypertension, pulmonary    nocardiosis, pulmonary tuberculosis, pulmonary veno-occlusive    disease, rheumatoid lung disease, sarcoidosis, and Wegener's    granulomatosis.-   19. The method of any preceding clause, wherein said antibody or    antibody fragment treats or reduces the risk in said human of at    least one condition selected from the group consisting of an airway    inflammatory disease or condition, chronic obstructive pulmonary    disease, asthma, pneumonia, hypersensitivity pneumonitis, pulmonary    infiltrate with eosinophilia, environmental lung disease, pneumonia,    bronchiectasis, cystic fibrosis, interstitial lung disease, primary    pulmonary hypertension, pulmonary thromboembolism, disorders of the    pleura, disorders of the mediastinum, disorders of the diaphragm,    hypoventilation, hyperventilation, sleep apnea, acute respiratory    distress syndrome, mesothelioma, sarcoma, graft rejection, graft    versus host disease, lung cancer, allergic rhinitis, allergy,    asbestosis, aspergilloma, aspergillosis, bronchiectasis, chronic    bronchitis, emphysema, eosinophilic pneumonia, idiopathic pulmonary    fibrosis, invasive pneumococcal disease, influenza, nontuberculous    mycobacteria, pleural effusion, pneumoconiosis, pneumocytosis,    pneumonia, pulmonary actinomycosis, pulmonary alveolar proteinosis,    pulmonary anthrax, pulmonary edema, pulmonary embolus, pulmonary    inflammation, pulmonary histiocytosis X, pulmonary hypertension,    pulmonary nocardiosis, pulmonary tuberculosis, pulmonary    veno-occlusive disease, rheumatoid lung disease, sarcoidosis, and    Wegener's granulomatosis-   20. The method of any preceding clause, wherein the nucleotide    sequence comprises one or more SNPs selected from the group    consisting of rs1805010, rs1805011, rs1805012, rs1805015, rs1801275    and rs1805016.-   21. The method of any preceding clause, wherein said antibody or    antibody fragment is administered by inhaled, intravenous or    subcutaneous administration and/or is comprised in an inhalable or    injectable preparation.-   22. The method of any preceding clause, wherein the VH domain    comprises the amino acid sequence of SEQ ID NO: 69.

Ligands with VH Tailoring

-   1. A ligand (eg, an antibody or antibody fragment) for use in a    method of treating or reducing the risk of an IL4Ra-mediated disease    or condition (eg, asthma) in a human in need thereof, wherein the    ligand specifically binds a human IL4RA protein that comprises a    mutation selected from the group consisting of I75V, E400A, C431R,    S503P, Q576R and S752A in SEQ ID NO: 67;    -   wherein (i) the ligand comprises a VH domain derived from the        recombination of a human VH segment, a human D gene segment and        a human JH segment, the human VH segment encoding the framework        1 of SEQ ID NO: 40 and wherein said human comprises a VH gene        segment encoding the framework 1 of SEQ ID NO: 40, or the human        expresses VH domains that comprise the framework 1 of SEQ ID NO:        40; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said IL4RA protein comprising said mutation selected from the        group consisting of I75V, E400A, C431R, S503P, Q576R and S752A        in SEQ ID NO: 67.    -   In an alternative, paragraph 1 provides:—    -   A ligand (eg, an antibody or antibody fragment) for use in a        method of targeting IL4Ra in a human, wherein the ligand        specifically binds a human IL4RA protein that comprises a        mutation selected from the group consisting of I75V, E400A,        C431R, S503P, Q576R and S752A in SEQ ID NO: 67;    -   wherein (i) the ligand comprises a VH domain derived from the        recombination of a human VH segment, a human D gene segment and        a human JH segment, the human VH segment encoding the framework        1 of SEQ ID NO: 40 and wherein said human comprises a VH gene        segment encoding the framework 1 of SEQ ID NO: 40, or the human        expresses VH domains that comprise the framework 1 of SEQ ID NO:        40; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said IL4RA protein comprising said mutation selected from the        group consisting of I75V, E400A, C431R, S503P, Q576R and S752A        in SEQ ID NO: 67.    -   In an example, the human is suffering from or at risk of an        IL4Ra-mediated disease or condition.    -   In an example, the method treats or reduces the risk of an        IL4Ra-mediated disease or condition in the human.-   2. The ligand of paragraph 1, wherein the IL4Ra comprises mutations    I75V and Q576R in SEQ ID NO: 67 and optionally the disease is    asthma.    -   The ligand of paragraph 1 or 2, wherein the nucleotide sequence        of (ii) comprises nucleotide mutation −3223T (dB SNP numbering).    -   The ligand of any preceding paragraph, wherein each said human        VH gene segment comprises SEQ ID NO: 39.-   3. The ligand of any preceding paragraph, wherein the VH gene    segment comprised by said human is a germline VH gene segment.-   4. The ligand of any preceding paragraph, said method comprising,    before said administering, selecting a human comprising said    nucleotide sequence of (ii), wherein the human is the human of    paragraph 1.-   5. The ligand of any preceding paragraph, wherein the human has been    determined to comprise the nucleotide sequence that encodes an IL4Ra    protein comprising said mutation selected from the group consisting    of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67    and/or an IL4Ra protein comprising said mutation selected from the    group consisting of I75V, E400A, C431R, S503P, Q576R and S752A in    SEQ ID NO: 67.-   6. The ligand of any preceding paragraph, said method comprising the    step of determining that the human comprises (a) the nucleotide    sequence that encodes an IL4Ra protein comprising said mutation    selected from the group consisting of I75V, E400A, C431R, S503P,    Q576R and S752A in SEQ ID NO: 67 and/or (b) an IL4Ra protein    comprising said mutation said mutation selected from the group    consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID    NO: 67, optionally, wherein the determining step is performed before    administration of the antibody to the human.-   7. The ligand of paragraph 8, wherein the step of determining    comprises assaying a biological sample from the human for a    nucleotide sequence encoding a IL4Ra protein comprising said    mutation selected from the group consisting of I75V, E400A, C431R,    S503P, Q576R and S752A in SEQ ID NO: 67.-   8. The ligand of paragraph 9, wherein the assaying comprises    -   contacting the biological sample with at least one        oligonucleotide probe comprising a sequence of at least 10        contiguous nucleotides of a nucleotide sequence encoding an        IL4Ra protein comprising said mutation selected from the group        consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ        ID NO: 67 or comprising an antisense sequence of said contiguous        nucleotides, wherein said sequence of contiguous nucleotides        comprises a nucleotide sequence encoding said mutation selected        from the group consisting of I75V, E400A, C431R, S503P, Q576R        and S752A in SEQ ID NO: 67, thereby forming a complex when at        least one nucleotide sequence encoding the IL4Ra protein        comprising said mutation selected from the group consisting of        I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67 is        present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the IL4Ra protein comprising said mutation selected        from the group consisting of I75V, E400A, C431R, S503P, Q576R        and S752A in SEQ ID NO: 67.-   9. The ligand of paragraph 9, wherein the assaying comprises nucleic    acid amplification and optionally one or more methods selected from    sequencing, next generation sequencing, nucleic acid hybridization,    and allele-specific amplification and/or wherein the assaying is    performed in a multiplex format.-   10. The ligand of paragraph 9 or 11, wherein said biological sample    comprises serum, blood, faeces, tissue, a cell, urine and/or saliva    of said human.-   11. The ligand of any preceding paragraph, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    IL4Ra protein comprising said mutation selected from the group    consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID    NO: 67, optionally, wherein said human is further indicated as    comprising the nucleotide sequence of SEQ ID NO: 68, or said human    is indicated as homozygous for a nucleotide sequence encoding the    IL4Ra protein comprising said mutation selected from the group    consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID    NO: 67.-   12. The ligand of any preceding paragraph, wherein said human is or    has been further determined to be substantially resistant to an    asthma treatment.-   13. The ligand of any preceding paragraph, wherein said human is    receiving or has received an asthma treatment or has reduced    responsiveness to an asthma treatment.-   14. The ligand of any preceding paragraph, wherein said disease or    condition is an inflammatory disease or condition; an atopic disease    or condition; a respiratory disease or condition; a disease or    condition associated with elevated IgE; or a disease or condition    associated with elevated IL-4 and/or IL-13 activity.-   15. The ligand of any preceding paragraph, wherein said disease or    condition is selected from the group consisting of an airway    inflammatory disease or condition, chronic obstructive pulmonary    disease, asthma, pneumonia, hypersensitivity pneumonitis, pulmonary    infiltrate with eosinophilia, environmental lung disease, pneumonia,    bronchiectasis, cystic fibrosis, interstitial lung disease, primary    pulmonary hypertension, pulmonary thromboembolism, disorders of the    pleura, disorders of the mediastinum, disorders of the diaphragm,    hypoventilation, hyperventilation, sleep apnea, acute respiratory    distress syndrome, mesothelioma, sarcoma, graft rejection, graft    versus host disease, lung cancer, allergic rhinitis, allergy,    asbestosis, aspergilloma, aspergillosis, bronchiectasis, chronic    bronchitis, emphysema, eosinophilic pneumonia, idiopathic pulmonary    fibrosis, invasive pneumococcal disease, influenza, nontuberculous    mycobacteria, pleural effusion, pneumoconiosis, pneumocytosis,    pneumonia, pulmonary actinomycosis, pulmonary alveolar proteinosis,    pulmonary anthrax, pulmonary edema, pulmonary embolus, pulmonary    inflammation, pulmonary histiocytosis X, pulmonary hypertension,    pulmonary nocardiosis, pulmonary tuberculosis, pulmonary    veno-occlusive disease, rheumatoid lung disease, sarcoidosis, and    Wegener's granulomatosis.-   16. The ligand of any preceding paragraph, wherein said human has    been diagnosed with at least one condition selected from the group    consisting of an airway inflammatory disease or condition, chronic    obstructive pulmonary disease, asthma, pneumonia, hypersensitivity    pneumonitis, pulmonary infiltrate with eosinophilia, environmental    lung disease, pneumonia, bronchiectasis, cystic fibrosis,    interstitial lung disease, primary pulmonary hypertension, pulmonary    thromboembolism, disorders of the pleura, disorders of the    mediastinum, disorders of the diaphragm, hypoventilation,    hyperventilation, sleep apnea, acute respiratory distress syndrome,    mesothelioma, sarcoma, graft rejection, graft versus host disease,    lung cancer, allergic rhinitis, allergy, asbestosis, aspergilloma,    aspergillosis, bronchiectasis, chronic bronchitis, emphysema,    eosinophilic pneumonia, idiopathic pulmonary fibrosis, invasive    pneumococcal disease, influenza, nontuberculous mycobacteria,    pleural effusion, pneumoconiosis, pneumocytosis, pneumonia,    pulmonary actinomycosis, pulmonary alveolar proteinosis, pulmonary    anthrax, pulmonary edema, pulmonary embolus, pulmonary inflammation,    pulmonary histiocytosis X, pulmonary hypertension, pulmonary    nocardiosis, pulmonary tuberculosis, pulmonary veno-occlusive    disease, rheumatoid lung disease, sarcoidosis, and Wegener's    granulomatosis.-   17. The ligand of any preceding paragraph, wherein said antibody or    antibody fragment treats or reduces the risk in said human of at    least one condition selected from the group consisting of an airway    inflammatory disease or condition, chronic obstructive pulmonary    disease, asthma, pneumonia, hypersensitivity pneumonitis, pulmonary    infiltrate with eosinophilia, environmental lung disease, pneumonia,    bronchiectasis, cystic fibrosis, interstitial lung disease, primary    pulmonary hypertension, pulmonary thromboembolism, disorders of the    pleura, disorders of the mediastinum, disorders of the diaphragm,    hypoventilation, hyperventilation, sleep apnea, acute respiratory    distress syndrome, mesothelioma, sarcoma, graft rejection, graft    versus host disease, lung cancer, allergic rhinitis, allergy,    asbestosis, aspergilloma, aspergillosis, bronchiectasis, chronic    bronchitis, emphysema, eosinophilic pneumonia, idiopathic pulmonary    fibrosis, invasive pneumococcal disease, influenza, nontuberculous    mycobacteria, pleural effusion, pneumoconiosis, pneumocytosis,    pneumonia, pulmonary actinomycosis, pulmonary alveolar proteinosis,    pulmonary anthrax, pulmonary edema, pulmonary embolus, pulmonary    inflammation, pulmonary histiocytosis X, pulmonary hypertension,    pulmonary nocardiosis, pulmonary tuberculosis, pulmonary    veno-occlusive disease, rheumatoid lung disease, sarcoidosis, and    Wegener's granulomatosis-   18. The ligand of any preceding paragraph, wherein the nucleotide    sequence comprises one or more SNPs selected from the group    consisting of rs1805010, rs1805011, rs1805012, rs1805015, rs1801275    and rs1805016.-   19. The ligand of any preceding paragraph, wherein said antibody or    antibody fragment is for inhaled, intravenous or subcutaneous    administration and/or is comprised in an inhalable or injectable    preparation.-   20. The ligand of any preceding paragraph, wherein the VH domain    comprises the amino acid sequence of SEQ ID NO: 69.

Methods with C Region Tailoring

-   1. A method of treating or reducing the risk of an IL4Ra-mediated    disease or condition in a human in need thereof, the method    comprising administering to said human a ligand (eg, an antibody or    antibody fragment) that specifically binds a human IL4Ra protein    that comprises a mutation selected from the group consisting of    I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67;    -   wherein the ligand comprises a human gamma-4 heavy chain        constant region that comprises a Leu at position 189 shown in        SEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73        and wherein said human comprises (i) an IGHG4*01 human heavy        chain constant region gene segment, or the human expresses        antibodies comprising human gamma-4 heavy chain constant regions        comprising a Leu at position 189 shown in SEQ ID NO: 73 or an        Arg at position 289 shown in SEQ ID NO: 73; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said IL4RA protein comprising said mutation selected from the        group consisting of I75V, E400A, C431R, S503P, Q576R and S752A        in SEQ ID NO: 67.    -   In an alternative, clause 1 provides:—    -   A method of targeting IL4Ra in a human, the method comprising        administering to said human a ligand (eg, an antibody or        antibody fragment) that specifically binds a human IL4Ra protein        that comprises a mutation selected from the group consisting of        I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67;    -   wherein the ligand comprises a human gamma-4 heavy chain        constant region that comprises a Leu at position 189 shown in        SEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73        and wherein said human comprises (i) an IGHG4*01 human heavy        chain constant region gene segment, or the human expresses        antibodies comprising human gamma-4 heavy chain constant regions        comprising a Leu at position 189 shown in SEQ ID NO: 73 or an        Arg at position 289 shown in SEQ ID NO: 73; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said IL4RA protein comprising said mutation selected from the        group consisting of I75V, E400A, C431R, S503P, Q576R and S752A        in SEQ ID NO: 67.

In an example, the human is suffering from or at risk of anIL4Ra-mediated disease or condition.

-   -   In an example, the method treats or reduces the risk of an        IL4Ra-mediated disease or condition in the human.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation I75V.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation E400A.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation C431R.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation S503P.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation Q576R.    -   In an example of the method or ligand of the invention, the        IL4Ra comprises mutation S752A.

-   2. The method of clause 1, wherein the IL4Ra comprises mutations    I75V and Q576R in SEQ ID NO: 67 and optionally the disease is    asthma.

-   3. The method of clause 1 or 2, wherein the nucleotide sequence    of (ii) comprises nucleotide mutation −3223T (dB SNP numbering).

-   4. The method of any preceding clause, wherein said human gamma-4    heavy chain constant region that comprises SEQ ID NO: 73.

-   5. The method of any preceding clause, wherein the human expresses    antibodies comprising human IGHG4*01 heavy chain constant regions.

-   6. The method of any preceding clause comprising, before said    administering, selecting a human comprising said nucleotide sequence    of (ii), wherein the human is the human of clause 1.

-   7. The method of any preceding clause, wherein the human has been    determined to comprise the nucleotide sequence that encodes an IL4Ra    protein comprising said mutation selected from the group consisting    of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67    and/or an IL4Ra protein comprising said mutation selected from the    group consisting of I75V, E400A, C431R, S503P, Q576R and S752A in    SEQ ID NO: 67.

-   8. The method of any preceding clause, comprising the step of    determining that the human comprises (a) the nucleotide sequence    that encodes an IL4Ra protein comprising said mutation selected from    the group consisting of I75V, E400A, C431R, S503P, Q576R and S752A    in SEQ ID NO: 67 and/or (b) an IL4Ra protein comprising said    mutation said mutation selected from the group consisting of I75V,    E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67, optionally,    wherein the determining step is performed before administration of    the antibody to the human.

-   9. The method of clause 8, wherein the step of determining comprises    assaying a biological sample from the human for a nucleotide    sequence encoding a IL4Ra protein comprising said mutation selected    from the group consisting of I75V, E400A, C431R, S503P, Q576R and    S752A in SEQ ID NO: 67.

-   10. The method of clause 9, wherein the assaying comprises    -   contacting the biological sample with at least one        oligonucleotide probe comprising a sequence of at least 10        contiguous nucleotides of a nucleotide sequence encoding an        IL4Ra protein comprising said mutation selected from the group        consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ        ID NO: 67 or comprising an antisense sequence of said contiguous        nucleotides, wherein said sequence of contiguous nucleotides        comprises a nucleotide sequence encoding said mutation selected        from the group consisting of I75V, E400A, C431R, S503P, Q576R        and S752A in SEQ ID NO: 67, thereby forming a complex when at        least one nucleotide sequence encoding the IL4Ra protein        comprising said mutation selected from the group consisting of        I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67 is        present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the IL4Ra protein comprising said mutation selected        from the group consisting of I75V, E400A, C431R, S503P, Q576R        and S752A in SEQ ID NO: 67.

-   11. The method of clause 9, wherein the assaying comprises nucleic    acid amplification and optionally one or more methods selected from    sequencing, next generation sequencing, nucleic acid hybridization,    and allele-specific amplification and/or wherein the assaying is    performed in a multiplex format.

-   12. The method of clause 9 or 11, wherein said biological sample    comprises serum, blood, faeces, tissue, a cell, urine and/or saliva    of said human.

-   13. The method of any preceding clause, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    IL4Ra protein comprising said mutation selected from the group    consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID    NO: 67, optionally, wherein said human is further indicated as    comprising the nucleotide sequence of SEQ ID NO: 68, or said human    is indicated as homozygous for a nucleotide sequence encoding the    IL4Ra protein comprising said mutation selected from the group    consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID    NO: 67.

-   14. The method of any preceding clause, wherein said human is or has    been further determined to be substantially resistant to an asthma    treatment.

-   15. The method of any preceding clause, wherein said human is    receiving or has received an asthma treatment or has reduced    responsiveness to an asthma treatment.

-   16. The method of any preceding clause, wherein said disease or    condition is an inflammatory disease or condition; an atopic disease    or condition; a respiratory disease or condition; a disease or    condition associated with elevated IgE; or a disease or condition    associated with elevated IL-4 and/or IL-13 activity.

-   17. The method of any preceding clause, wherein said disease or    condition is selected from the group consisting of an airway    inflammatory disease or condition, chronic obstructive pulmonary    disease, asthma, pneumonia, hypersensitivity pneumonitis, pulmonary    infiltrate with eosinophilia, environmental lung disease, pneumonia,    bronchiectasis, cystic fibrosis, interstitial lung disease, primary    pulmonary hypertension, pulmonary thromboembolism, disorders of the    pleura, disorders of the mediastinum, disorders of the diaphragm,    hypoventilation, hyperventilation, sleep apnea, acute respiratory    distress syndrome, mesothelioma, sarcoma, graft rejection, graft    versus host disease, lung cancer, allergic rhinitis, allergy,    asbestosis, aspergilloma, aspergillosis, bronchiectasis, chronic    bronchitis, emphysema, eosinophilic pneumonia, idiopathic pulmonary    fibrosis, invasive pneumococcal disease, influenza, nontuberculous    mycobacteria, pleural effusion, pneumoconiosis, pneumocytosis,    pneumonia, pulmonary actinomycosis, pulmonary alveolar proteinosis,    pulmonary anthrax, pulmonary edema, pulmonary embolus, pulmonary    inflammation, pulmonary histiocytosis X, pulmonary hypertension,    pulmonary nocardiosis, pulmonary tuberculosis, pulmonary    veno-occlusive disease, rheumatoid lung disease, sarcoidosis, and    Wegener's granulomatosis.

-   18. The method of any preceding clause, wherein said human has been    diagnosed with at least one condition selected from the group    consisting of an airway inflammatory disease or condition, chronic    obstructive pulmonary disease, asthma, pneumonia, hypersensitivity    pneumonitis, pulmonary infiltrate with eosinophilia, environmental    lung disease, pneumonia, bronchiectasis, cystic fibrosis,    interstitial lung disease, primary pulmonary hypertension, pulmonary    thromboembolism, disorders of the pleura, disorders of the    mediastinum, disorders of the diaphragm, hypoventilation,    hyperventilation, sleep apnea, acute respiratory distress syndrome,    mesothelioma, sarcoma, graft rejection, graft versus host disease,    lung cancer, allergic rhinitis, allergy, asbestosis, aspergilloma,    aspergillosis, bronchiectasis, chronic bronchitis, emphysema,    eosinophilic pneumonia, idiopathic pulmonary fibrosis, invasive    pneumococcal disease, influenza, nontuberculous mycobacteria,    pleural effusion, pneumoconiosis, pneumocytosis, pneumonia,    pulmonary actinomycosis, pulmonary alveolar proteinosis, pulmonary    anthrax, pulmonary edema, pulmonary embolus, pulmonary inflammation,    pulmonary histiocytosis X, pulmonary hypertension, pulmonary    nocardiosis, pulmonary tuberculosis, pulmonary veno-occlusive    disease, rheumatoid lung disease, sarcoidosis, and Wegener's    granulomatosis.

-   19. The method of any preceding clause, wherein said antibody or    antibody fragment treats or reduces the risk in said human of at    least one condition selected from the group consisting of an airway    inflammatory disease or condition, chronic obstructive pulmonary    disease, asthma, pneumonia, hypersensitivity pneumonitis, pulmonary    infiltrate with eosinophilia, environmental lung disease, pneumonia,    bronchiectasis, cystic fibrosis, interstitial lung disease, primary    pulmonary hypertension, pulmonary thromboembolism, disorders of the    pleura, disorders of the mediastinum, disorders of the diaphragm,    hypoventilation, hyperventilation, sleep apnea, acute respiratory    distress syndrome, mesothelioma, sarcoma, graft rejection, graft    versus host disease, lung cancer, allergic rhinitis, allergy,    asbestosis, aspergilloma, aspergillosis, bronchiectasis, chronic    bronchitis, emphysema, eosinophilic pneumonia, idiopathic pulmonary    fibrosis, invasive pneumococcal disease, influenza, nontuberculous    mycobacteria, pleural effusion, pneumoconiosis, pneumocytosis,    pneumonia, pulmonary actinomycosis, pulmonary alveolar proteinosis,    pulmonary anthrax, pulmonary edema, pulmonary embolus, pulmonary    inflammation, pulmonary histiocytosis X, pulmonary hypertension,    pulmonary nocardiosis, pulmonary tuberculosis, pulmonary    veno-occlusive disease, rheumatoid lung disease, sarcoidosis, and    Wegener's granulomatosis

-   20. The method of any preceding clause, wherein the nucleotide    sequence comprises one or more SNPs selected from the group    consisting of rs1805010, rs1805011, rs1805012, rs1805015, rs1801275    and rs1805016.

-   21. The method of any preceding clause, wherein said antibody or    antibody fragment is administered by inhaled, intravenous or    subcutaneous administration and/or is comprised in an inhalable or    injectable preparation.

Ligands with Constant Region Tailoring

-   1. A ligand (eg, an antibody or antibody fragment) for use in a    method of treating or reducing the risk of an IL4Ra-mediated disease    or condition (eg, asthma) in a human in need thereof, wherein the    ligand specifically binds a human IL4RA protein that comprises a    mutation selected from the group consisting of I75V, E400A, C431R,    S503P, Q576R and S752A in SEQ ID NO: 67;    -   wherein (i) the ligand comprises a human gamma-4 heavy chain        constant region that comprises a Leu at position 189 shown in        SEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73        and wherein said human comprises (i) an IGHG4*01 human heavy        chain constant region gene segment, or the human expresses        antibodies comprising human gamma-4 heavy chain constant regions        comprising a Leu at position 189 shown in SEQ ID NO: 73 or an        Arg at position 289 shown in SEQ ID NO: 73; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said IL4RA protein comprising said mutation selected from the        group consisting of I75V, E400A, C431R, S503P, Q576R and S752A        in SEQ ID NO: 67.    -   In an alternative, paragraph 1 provides:—    -   A ligand (eg, an antibody or antibody fragment) for use in a        method of targeting IL4Ra in a human, wherein the ligand        specifically binds a human IL4RA protein that comprises a        mutation selected from the group consisting of I75V, E400A,        C431R, S503P, Q576R and S752A in SEQ ID NO: 67;    -   wherein (i) the ligand comprises a human gamma-4 heavy chain        constant region that comprises a Leu at position 189 shown in        SEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73        and wherein said human comprises (i) an IGHG4*01 human heavy        chain constant region gene segment, or the human expresses        antibodies comprising human gamma-4 heavy chain constant regions        comprising a Leu at position 189 shown in SEQ ID NO: 73 or an        Arg at position 289 shown in SEQ ID NO: 73; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said IL4RA protein comprising said mutation selected from the        group consisting of I75V, E400A, C431R, S503P, Q576R and S752A        in SEQ ID NO: 67.    -   In an example, the human is suffering from or at risk of an        IL4Ra-mediated disease or condition.    -   In an example, the method treats or reduces the risk of an        IL4Ra-mediated disease or condition in the human.-   2. The ligand of paragraph 1, wherein the IL4Ra comprises mutations    I75V and Q576R in SEQ ID NO: 67 and optionally the disease is    asthma.-   3. The ligand of paragraph 1 or 2, wherein the nucleotide sequence    of (ii) comprises nucleotide mutation −3223T (dB SNP numbering).-   4. The ligand of any preceding paragraph, wherein said human gamma-4    heavy chain constant region that comprises SEQ ID NO: 73.-   5. The ligand of any preceding paragraph, wherein the human    expresses antibodies comprising human IGHG4*01 heavy chain constant    regions.-   6. The ligand of any preceding paragraph, said method comprising,    before said administering, selecting a human comprising said    nucleotide sequence of (ii), wherein the human is the human of    paragraph 1.-   7. The ligand of any preceding paragraph, wherein the human has been    determined to comprise the nucleotide sequence that encodes an IL4Ra    protein comprising said mutation selected from the group consisting    of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67    and/or an IL4Ra protein comprising said mutation selected from the    group consisting of I75V, E400A, C431R, S503P, Q576R and S752A in    SEQ ID NO: 67.-   8. The ligand of any preceding paragraph, said method comprising the    step of determining that the human comprises (a) the nucleotide    sequence that encodes an IL4Ra protein comprising said mutation    selected from the group consisting of I75V, E400A, C431R, S503P,    Q576R and S752A in SEQ ID NO: 67 and/or (b) an IL4Ra protein    comprising said mutation said mutation selected from the group    consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID    NO: 67, optionally, wherein the determining step is performed before    administration of the antibody to the human.-   9. The ligand of paragraph 8, wherein the step of determining    comprises assaying a biological sample from the human for a    nucleotide sequence encoding a IL4Ra protein comprising said    mutation selected from the group consisting of I75V, E400A, C431R,    S503P, Q576R and S752A in SEQ ID NO: 67.-   10. The ligand of paragraph 9, wherein the assaying comprises    -   contacting the biological sample with at least one        oligonucleotide probe comprising a sequence of at least 10        contiguous nucleotides of a nucleotide sequence encoding an        IL4Ra protein comprising said mutation selected from the group        consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ        ID NO: 67 or comprising an antisense sequence of said contiguous        nucleotides, wherein said sequence of contiguous nucleotides        comprises a nucleotide sequence encoding said mutation selected        from the group consisting of I75V, E400A, C431R, S503P, Q576R        and S752A in SEQ ID NO: 67, thereby forming a complex when at        least one nucleotide sequence encoding the IL4Ra protein        comprising said mutation selected from the group consisting of        I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID NO: 67 is        present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the IL4Ra protein comprising said mutation selected        from the group consisting of I75V, E400A, C431R, S503P, Q576R        and S752A in SEQ ID NO: 67.-   11. The ligand of paragraph 9, wherein the assaying comprises    nucleic acid amplification and optionally one or more methods    selected from sequencing, next generation sequencing, nucleic acid    hybridization, and allele-specific amplification and/or wherein the    assaying is performed in a multiplex format.-   12. The ligand of paragraph 9 or 11, wherein said biological sample    comprises serum, blood, faeces, tissue, a cell, urine and/or saliva    of said human.-   13. The ligand of any preceding paragraph, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    IL4Ra protein comprising said mutation selected from the group    consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID    NO: 67, optionally, wherein said human is further indicated as    comprising the nucleotide sequence of SEQ ID NO: 68, or said human    is indicated as homozygous for a nucleotide sequence encoding the    IL4Ra protein comprising said mutation selected from the group    consisting of I75V, E400A, C431R, S503P, Q576R and S752A in SEQ ID    NO: 67.-   14. The ligand of any preceding paragraph, wherein said human is or    has been further determined to be substantially resistant to an    asthma treatment.-   15. The ligand of any preceding paragraph, wherein said human is    receiving or has received an asthma treatment or has reduced    responsiveness to an asthma treatment.-   16. The ligand of any preceding paragraph, wherein said disease or    condition is an inflammatory disease or condition; an atopic disease    or condition; a respiratory disease or condition; a disease or    condition associated with elevated IgE; or a disease or condition    associated with elevated IL-4 and/or IL-13 activity.-   17. The ligand of any preceding paragraph, wherein said disease or    condition is selected from the group consisting of an airway    inflammatory disease or condition, chronic obstructive pulmonary    disease, asthma, pneumonia, hypersensitivity pneumonitis, pulmonary    infiltrate with eosinophilia, environmental lung disease, pneumonia,    bronchiectasis, cystic fibrosis, interstitial lung disease, primary    pulmonary hypertension, pulmonary thromboembolism, disorders of the    pleura, disorders of the mediastinum, disorders of the diaphragm,    hypoventilation, hyperventilation, sleep apnea, acute respiratory    distress syndrome, mesothelioma, sarcoma, graft rejection, graft    versus host disease, lung cancer, allergic rhinitis, allergy,    asbestosis, aspergilloma, aspergillosis, bronchiectasis, chronic    bronchitis, emphysema, eosinophilic pneumonia, idiopathic pulmonary    fibrosis, invasive pneumococcal disease, influenza, nontuberculous    mycobacteria, pleural effusion, pneumoconiosis, pneumocytosis,    pneumonia, pulmonary actinomycosis, pulmonary alveolar proteinosis,    pulmonary anthrax, pulmonary edema, pulmonary embolus, pulmonary    inflammation, pulmonary histiocytosis X, pulmonary hypertension,    pulmonary nocardiosis, pulmonary tuberculosis, pulmonary    veno-occlusive disease, rheumatoid lung disease, sarcoidosis, and    Wegener's granulomatosis.-   18. The ligand of any preceding paragraph, wherein said human has    been diagnosed with at least one condition selected from the group    consisting of an airway inflammatory disease or condition, chronic    obstructive pulmonary disease, asthma, pneumonia, hypersensitivity    pneumonitis, pulmonary infiltrate with eosinophilia, environmental    lung disease, pneumonia, bronchiectasis, cystic fibrosis,    interstitial lung disease, primary pulmonary hypertension, pulmonary    thromboembolism, disorders of the pleura, disorders of the    mediastinum, disorders of the diaphragm, hypoventilation,    hyperventilation, sleep apnea, acute respiratory distress syndrome,    mesothelioma, sarcoma, graft rejection, graft versus host disease,    lung cancer, allergic rhinitis, allergy, asbestosis, aspergilloma,    aspergillosis, bronchiectasis, chronic bronchitis, emphysema,    eosinophilic pneumonia, idiopathic pulmonary fibrosis, invasive    pneumococcal disease, influenza, nontuberculous mycobacteria,    pleural effusion, pneumoconiosis, pneumocytosis, pneumonia,    pulmonary actinomycosis, pulmonary alveolar proteinosis, pulmonary    anthrax, pulmonary edema, pulmonary embolus, pulmonary inflammation,    pulmonary histiocytosis X, pulmonary hypertension, pulmonary    nocardiosis, pulmonary tuberculosis, pulmonary veno-occlusive    disease, rheumatoid lung disease, sarcoidosis, and Wegener's    granulomatosis.-   19. The ligand of any preceding paragraph, wherein said antibody or    antibody fragment treats or reduces the risk in said human of at    least one condition selected from the group consisting of an airway    inflammatory disease or condition, chronic obstructive pulmonary    disease, asthma, pneumonia, hypersensitivity pneumonitis, pulmonary    infiltrate with eosinophilia, environmental lung disease, pneumonia,    bronchiectasis, cystic fibrosis, interstitial lung disease, primary    pulmonary hypertension, pulmonary thromboembolism, disorders of the    pleura, disorders of the mediastinum, disorders of the diaphragm,    hypoventilation, hyperventilation, sleep apnea, acute respiratory    distress syndrome, mesothelioma, sarcoma, graft rejection, graft    versus host disease, lung cancer, allergic rhinitis, allergy,    asbestosis, aspergilloma, aspergillosis, bronchiectasis, chronic    bronchitis, emphysema, eosinophilic pneumonia, idiopathic pulmonary    fibrosis, invasive pneumococcal disease, influenza, nontuberculous    mycobacteria, pleural effusion, pneumoconiosis, pneumocytosis,    pneumonia, pulmonary actinomycosis, pulmonary alveolar proteinosis,    pulmonary anthrax, pulmonary edema, pulmonary embolus, pulmonary    inflammation, pulmonary histiocytosis X, pulmonary hypertension,    pulmonary nocardiosis, pulmonary tuberculosis, pulmonary    veno-occlusive disease, rheumatoid lung disease, sarcoidosis, and    Wegener's granulomatosis-   20. The ligand of any preceding paragraph, wherein the nucleotide    sequence comprises one or more SNPs selected from the group    consisting of rs1805010, rs1805011, rs1805012, rs1805015, rs1801275    and rs1805016.-   21. The ligand of any preceding paragraph, wherein said antibody or    antibody fragment is for inhaled, intravenous or subcutaneous    administration and/or is comprised in an inhalable or injectable    preparation.

In an example of any other example or embodiment, clause or paragraphrelating to IL4Ra, the IL4Ra mutation is 75V and the human is of AFR orASN ancestry, eg, the ancestry of the human is selected from ASW, LWK,CHS or JPT. All of these ancestries have greater than the average of 47%frequency for 75V.

In an example of any other example or embodiment, clause or paragraphrelating to IL4Ra, the IL4Ra mutation is 400A and the human is of AFRancestry, eg, the ancestry of the human is selected from ASW, LWK andYRI. All of these ancestries have greater than the average frequency for400A.

In an example of any other example or embodiment, clause or paragraphrelating to IL4Ra, the IL4Ra mutation is 431R and the human is of AFR orAMR ancestry, eg, the ancestry of the human is selected from YRI, CLM,MXL, PUR or CEU. All of these ancestries have greater than the averagefrequency for 431R.

In an example of any other example or embodiment, clause or paragraphrelating to IL4Ra, the IL4Ra mutation is 752A and the human is of AFRancestry, eg, the ancestry of the human is selected from ASW, LWK andYRI. All of these ancestries have 37-39% frequency, which is greaterthan the average frequency for 752A.

Frequencies are with reference to the 1000 Genomes database (version20110521) here.

In an example of any other example or embodiment, clause or paragraphrelating to IL4Ra, the IL4Ra mutation is 75V and the human is of AFR orASN ancestry, eg, the ancestry of the human is selected from ASW, LWK,CHS or JPT. All of these ancestries have greater than the average of 47%frequency for 75V.

Example 3 Nav1.7 (SCN9A; ETHA; FEB3B; GEFSP7; NE-NA; NENA; PN1; SFNP)

Reference is made to J Clin Invest. 2007 December; 117(12):3603-9,“Mutations in sodium-channel gene SCN9A cause a spectrum of humangenetic pain disorders”, Drenth JP & Waxman SG (incorporated herein byreference). Voltage-gated sodium channels play a critical role in thegeneration and conduction of action potentials and are thus importantfor electrical signalling by most excitable cells. Sodium channels areintegral membrane proteins and are comprised of a large a subunit, whichforms the voltage-sensitive and ion-selective pore, and smallerauxiliary β subunit(s) that can modulate the kinetics and voltagedependence of channel gating. To date, we know of 9 isoforms of thesodium-channel a subunit (Nav1.1-Nav1.9), each with a unique central andperipheral nervous system distribution. Four closely related sodiumchannels (Nav1.1, -1.2, -1.3, and -1.7) are encoded by a set of 4 genes(SCN1A, SCN2A, SCN3A, and SCN9A, respectively) located within a clusteron chromosome 2q24.3. Nav1.7 has a critical role in pain sensation.Furthermore, from KO studies and animal pain models, it would appearthat Nav1.7 plays a major role in inflammatory pain.

Nav1.7 is located in peripheral neurons and plays an important role inaction potential production in these cells. Recent genetic studies haveidentified Nav1.7 dysfunction in three different human pain disorders.Gain-of-function missense mutations in Nav1.7 have been shown to causeprimary erythermalgia (PE) and paroxysmal extreme pain disorder (PEPD),while nonsense mutations in Nav1.7 result in loss of Nav1.7 function anda condition known as channelopathy-associated insensitivity to pain(CIP), a rare disorder in which affected individuals are unable to feelphysical pain. Recent work has shown that different types ofchannelopathies (diseases caused by disturbed function of ion channelsubunits or the proteins that regulate them), all involving the sameNav1.7 sodium channel, underlie these disorders.

Nav1.7 is encoded by SCN9A, a 113.5-kb gene comprising 26 exons (OMIM603415) (FIG. 1A, Drenth & Waxman) The encoded sodium channel iscomposed of 1977 amino acids organized into 4 domains, each with 6transmembrane segments, and is predominantly expressed in the dorsalroot ganglion (DRG) neurons and sympathetic ganglion neurons (FIG. 1B,Drenth & Waxman) Immunohistochemical studies show that Nav1.7 is presentat the distal ends of the wire-like projections of neurons known asneurites, close to the impulse trigger zone where neuronal firing isinitiated. Interestingly, the large majority of DRG neurons that expressNav1.7 are pain sensing (nociceptive), suggesting a role for this sodiumchannel in the pathogenesis of pain.

Cell. 2014 Jun. 5; 157(6):1393-404. doi: 10.1016/j.cell.2014.03.064.Epub 2014 May 22; “A monoclonal antibody that targets a NaV1.7 channelvoltage sensor for pain and itch relief”, Lee J H et al and 2011 (bothincorporated herein by reference) describe the generation of amonoclonal antibody against human Nav1.7.

In an example, the invention provides a method of treating or reducingthe risk of a Nav1.7-mediated disease or condition in a human in needthereof, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human Nav1.7protein. The invention also provides a corresponding ligand.

The present invention provides anti-Nav1.7 ligands; and Nav1.7-bindingor targeting ligands as described herein. The ligands have a variety ofutilities. Some of the ligands, for instance, are useful in specificbinding assays, for genotyping or phenotyping humans, affinitypurification of Nav1.7, in particular human Nav1.7 or its ligands and inscreening assays to identify other antagonists of Nav1.7 activity. Someof the ligands of the invention are useful for inhibitingNav1.7-mediated activities.

Anti-Nav1.7 ligands (eg, antibodies and anti-sense RNA) have beendeveloped based on targeting and neutralising so-called “wild-type”human Nav1.7, which is a commonly-occurring form (see, eg, SEQ ID NO:75). While such therapies are useful for human patients harbouring thisform of human NAV1.7, the inventor considered it useful to investigatethe possibility of targeting rarer—but still naturally-occurring—formsof Nav1.7 amongst human populations. In this way, the inventor arrivedat insight into the natural occurrences and distributions of rarer humanNav1.7 forms that can serve as useful targets (at the protein or nucleicacid level) for human treatment, prophylaxis and diagnosis pertinent todiseases and conditions mediated or associated with NAV1.7 activity.This particularly provides for tailored therapies, prophylaxis anddiagnosis in humans that are devoid of the common Nav1.7 gene orprotein.

The skilled person will know that SNPs or other changes that translateinto amino acid variation can cause variability in activity and/orconformation of human targets to be addressed. This has spawned greatinterest in personalized medicine where genotyping and knowledge ofprotein and nucleotide variability is used to more effectively tailormedicines and diagnosis of patients. The invention, therefore, providesfor tailored pharmaceuticals and testing that specifically addressesrarer Nav1.7 polymorphic variant forms. Such forms or “alleles” (at thenucleotide level), comprise one or more changes at the nucleotide andamino acid levels from the corresponding common form nucleotide andamino acids sequences, ie, there are one or more non-synonymous (aka“missense”) changes at the nucleotide level that translate into one ormore corresponding changes in the protein target in humans.

Furthermore, the inventor surprisingly realised that the rarer naturalforms, although present in humans at much lower frequencies than thecommon form, nevertheless are represented in multiple andethnically-diverse human populations and usually with many humanexamples per represented ethnic population. Thus, the inventor realisedthat targeting such rarer forms would provide for effective treatment,prophylaxis or diagnosis across many human ethnic populations, therebyextending the utility of the present invention.

With this realisation, the inventor saw that there is significantindustrial and medical application for the invention in terms of guidingthe choice of anti-Nav1.7 ligand for administration to human patientsfor therapy and/or prophylaxis of Nav1.7-mediated or associated diseasesor conditions. In this way, the patient receives drugs and ligands thatare tailored to their needs—as determined by the patient's genetic orphenotypic makeup. Hand-in-hand with this, the invention provides forthe genotyping and/or phenotyping of patients in connection with suchtreatment, thereby allowing a proper match of drug to patient. Thisincreases the chances of medical efficacy, reduces the likelihood ofinferior treatment using drugs or ligands that are not matched to thepatient (eg, poor efficacy and/or side-effects) and avoidspharmaceutical mis-prescription and waste.

In developing this thinking, in this non-limiting example the presentinventor decided to determine a set of human Nav1.7 variants on thebasis of the following criteria, these being criteria that the inventorrealised would provide for useful medical drugs and diagnostics totailored need in the human population. The inventor selected variantshaving at least 3 of the 4 following criteria:—

Naturally-occurring human Nav1.7 variation having a cumulative humanallele frequency of 35% or less;

Naturally-occurring human Nav1.7 variation having a total human genotypefrequency of about 50% or less;

Naturally-occurring human Nav1.7 variation found in many different humanethnic populations (using the standard categorisation of the 1000Genomes Project; see Table 2 below); and

Naturally-occurring human Nav1.7 variation found in many individualsdistributed across such many different ethnic populations.

On the basis of these criteria, the inventor identified variants listedin Table 12 (see Further Variants) below. The inventor's selectionincluded, as an additional or alternative consideration, selection fornucleotide variation that produced amino acid variation in correspondingNav1.7 forms (ie, non-synonymous variations), as opposed to silentvariations that do not alter amino acid residues in the target protein.

In an example, the invention provides a method of treating or reducingthe risk of a Nav1.7-mediated disease or condition in a human in needthereof, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human Nav1.7protein that comprises an amino acid selected from the group consistingof 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an aminoacid other than R), 328X (wherein X is an amino acid other than Y),395K, 459X (wherein X is an amino acid other than S), 693 X (wherein Xis an amino acid other than E), 767X (wherein X is an amino acid otherthan I), 830X (wherein X is an amino acid other than R), 897X (wherein Xis an amino acid other than W), 1200L, 1235L, 1488X (wherein X is anamino acid other than R), 1659X (wherein X is an amino acid other thanK), 1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,1002L, 1161W and 1919G. As explained further below, these amino acidvariations are found in naturally-occurring Nav1.7 variants in humansfound in many populations. Said human comprises a nucleotide sequenceencoding said Nav1.7 protein comprising said amino acid selected fromthe group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P,1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X(wherein X is an amino acid other than R), 328X (wherein X is an aminoacid other than Y), 395K, 459X (wherein X is an amino acid other thanS), 693 X (wherein X is an amino acid other than E), 767X (wherein X isan amino acid other than I), 830X (wherein X is an amino acid other thanR), 897X (wherein X is an amino acid other than W), 1200L, 1235L, 1488X(wherein X is an amino acid other than R), 1659X (wherein X is an aminoacid other than K), 1689X (wherein X is an amino acid other than W),422D, 490N, 943L, 1002L, 1161W and 1919G.

For example, said amino acid is selected from the group consisting ofany one of (a) to (e):—

-   -   a) 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P and 1449V; or    -   b) 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I and 1627K; or    -   c) 277X (wherein X is an amino acid other than R), 328X (wherein        X is an amino acid other than Y), 395K, 459X (wherein X is an        amino acid other than S), 693 X (wherein X is an amino acid        other than E), 767X (wherein X is an amino acid other than I),        830X (wherein X is an amino acid other than R), 897X (wherein X        is an amino acid other than W), 1200L, 1235L, 1488X (wherein X        is an amino acid other than R), 1659X (wherein X is an amino        acid other than K) and 1689X (wherein X is an amino acid other        than W); or    -   d) 395K, 1200L and 1235L; or    -   e) 422D, 490N, 943L, 1002L, 1161W and 1919G.        Amino acids (a)-(d) are discussed in Drenth & Waxman as being        associated with pain conditions (either undesirable elevated or        reduced pain). Thus, in one embodiment, the disease or condition        is a pain disease or condition and the amino acid is selected        from (a), (b), (c) or (d). Thus, in one embodiment, the disease        or condition is an itching disease or condition and the amino        acid is selected from (a), (b), (c) or (d). In an example, the        disease is PE and the amino acid is selected from (a). In an        example, the disease is PEPD and the amino acid is selected from        (b). In an example, the disease is CIP and the amino acid is        selected from (c) or (d). In an example, the disease or        condition is a pain or itching disease or condition and the        amino acid is selected from (e).

In one embodiment, the pain is chronic pain.

In one embodiment, the pain is neuropathic pain, eg, chronic neuropathicpain. For example, the pain is painful diabetic neuropathy (PDN),post-herpetic neuropathy (PHN) or trigeminal neuralgia (TN).

In an example, the pain is spinal cord injury pain, multiple sclerosispain, phantom limb pain, post-stroke pain, chronic back pain,osteoarthritis pain, cancer-associated pain or HIV-associated pain.

In one embodiment, the pain is inflammatory pain, eg, chronicinflammatory pain.

In one embodiment, the disease or condition is a channelopathy orassociated with a channelopathy.

In one embodiment, the disease or condition is selected from the groupconsisting of primary erythermalgia (PE), paroxysmal extreme paindisorder (PEPD) and channelopathy-associated insensitivity to pain(CIP).

Optionally, the NAV-mediated disease or condition is selected from anyone of the following:

-   -   a. Neuropathic or neurogenic pain (for example arising from        painful diabetic neuropathy (PDN), post-herpetic neuropathy        (PHN), central neuropathy, peripheral neuropathy, trigeminal        neuralgia (TN), anaesthesia dolorosa, spinal cord injuries,        multiple sclerosis, phantom limb pain, hyperalgesia,        hyperpathia, paresthesia, psychogenic pain, post-stroke pain and        HIV-associated pain, back pain, chronic back pain,        osteoarthritis, cancer, breakthrough pain, erythromelalgia [e.g.        primary erythromelalgia], paroxysmal 30 extreme pain disorder,        nerve compression and/or entrapment [such as carpal tunnel        syndrome, tarsal tunnel syndrome, ulnar nerve entrapment,        compression radiculopathy, radicular low back pain, spinal root        lesions, spinal root compression, lumbar spinal stenosis,        sciatic nerve compression, intercostal neuralgia], neuritis,        pain from chemotherapy, congenital defect/channelopathy [e.g.        channelopathy-associated insensitivity to pain and congenital        insensitivity to pain] or chronic alcoholism [alcoholic        polyneuropathy]);    -   b. inflammatory pain (such as osteoarthritis pain, chronic back        pain, rheumatoid arthritis pain, cancer pain, breakthrough pain,        pain associated with burns, encephalitis pain, bone fracture        pain, neuritis pain, autoimmune disease pain, postoperative        pain, dental pain, pain associated with bacterial infection,        pain associated with radiotherapy, pain associated with gout and        irritable bowel syndrome pain);    -   c. pain from trauma (such as from lacerations, incisions, burns,        foreign bodies or bullet and/or shrapnel injuries, spinal cord        injury, brachial plexus avulsion, nerve crush and/or entrapment        (such as carpal tunnel syndrome, tarsal tunnel syndrome, ulnar        nerve entrapment, compression radiculopathy, radicular low back        pain, spinal root lesions, spinal root compression, lumbar        spinal stenosis, sciatic nerve compression, intercostal        neuralgia), nerve transection, post-operative pain, dental pain        and toxic exposure);    -   d. pain from infection (such as post-herpetic neuropathy (PHN),        HIV-associated pain small pox infection, encephalitis, herpes        infection, and bacterial infection);    -   e. pain from malignancy (such as cancer pain, breakthrough pain,        and nerve compression pain);    -   f. visceral pain (such as renal or ureteral colic, irritable        bowel syndrome, angina or cardiac pain, cardiac arrhythmia,        period pain, interstitial cystitis, rectal pain, pain associated        with diarrhoea, appendicitis, cholecystitis and pancreatitis);    -   g. metabolic or chronic disease pain (such as associated with        multiple sclerosis, cancer pain, breakthrough pain, pain        associated with gout, peripheral diabetic neuropathy, pain        associated with chronic alcoholism [alcoholic polyneuropathy],        uremia pain, pain associated with hypothyroidism and pain        associated with vitamin deficiency);    -   h. headache pain (such as tension headache, migraine and cluster        headache);    -   i. idiopathic pain (such as trigeminal neuralgia, a complex        regional pain syndrome [e.g. complex regional pain syndrome I        and/or complex regional pain syndrome II], allodynia or        fibromyalgia);    -   j. respiratory pain (such as pain associated with asthma, airway        hyper-reactivity in asthma, chronic cough, e.g. in asthma and/or        chronic obstructive pulmonary disorder); or    -   k. other pain (such as pain associated with hormonal therapy,        diabetes, hypothyroidism, epilepsy, ataxia, periodic paralysis,        acute itch or chronic itch).

In an example, the NAV-mediated disease or condition is selected frompainful diabetic neuropathy, post-herpetic neuropathy, trigeminalneuralgia, osteoarthritis, chronic back pain, nerve compression pain(e.g. sciatic nerve compression) or cancer pain; or is selected frommigraine, post-operative pain and fibromyalgia.

In an example, the ligand of the invention comprises an anti-humanNav1.7 binding site, wherein the binding site is a human or humanizedbinding site, eg, the binding site comprises or consists of a human orhumanized antibody variable domain or plurality of variable domains (eg,human VH/VL binding site(s)). Additionally or alternatively, the ligandcomprises one or more human antibody constant regions (eg, a humanantibody CH1, CH2, CH3 (or all of these) or Fc). In an example, theligand is an antibody that comprises human or humanized variable regionsand human constant regions (eg, bearing one or more mutations to enhanceor dampen Fc function in a human patient).

An example provides a ligand (eg, an antibody or antibody fragment) fortreating or reducing the risk of a Nav1.7-mediated disease or conditionin a human in need thereof, the method comprising administering to saidhuman said ligand, wherein the ligand specifically binds a human Nav1.7protein that comprises an amino acid selected from the group consistingof 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an aminoacid other than R), 328X (wherein X is an amino acid other than Y),395K, 459X (wherein X is an amino acid other than S), 693 X (wherein Xis an amino acid other than E), 767X (wherein X is an amino acid otherthan I), 830X (wherein X is an amino acid other than R), 897X (wherein Xis an amino acid other than W), 1200L, 1235L, 1488X (wherein X is anamino acid other than R), 1659X (wherein X is an amino acid other thanK), 1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,1002L, 1161W and 1919G. Said human comprises a nucleotide sequenceencoding said Nav1.7 protein comprising said amino acid selected fromthe group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P,1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X(wherein X is an amino acid other than R), 328X (wherein X is an aminoacid other than Y), 395K, 459X (wherein X is an amino acid other thanS), 693 X (wherein X is an amino acid other than E), 767X (wherein X isan amino acid other than I), 830X (wherein X is an amino acid other thanR), 897X (wherein X is an amino acid other than W), 1200L, 1235L, 1488X(wherein X is an amino acid other than R), 1659X (wherein X is an aminoacid other than K), 1689X (wherein X is an amino acid other than W),422D, 490N, 943L, 1002L, 1161W and 1919G.

In an example, the invention provides a method of targeting Nav1.7 in ahuman, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human Nav1.7protein that comprises an amino acid selected from the group consistingof 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an aminoacid other than R), 328X (wherein X is an amino acid other than Y),395K, 459X (wherein X is an amino acid other than S), 693 X (wherein Xis an amino acid other than E), 767X (wherein X is an amino acid otherthan I), 830X (wherein X is an amino acid other than R), 897X (wherein Xis an amino acid other than W), 1200L, 1235L, 1488X (wherein X is anamino acid other than R), 1659X (wherein X is an amino acid other thanK), 1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,1002L, 1161W and 1919G. Said human comprises a nucleotide sequenceencoding said Nav1.7 protein comprising said amino acid selected fromthe group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P,1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X(wherein X is an amino acid other than R), 328X (wherein X is an aminoacid other than Y), 395K, 459X (wherein X is an amino acid other thanS), 693 X (wherein X is an amino acid other than E), 767X (wherein X isan amino acid other than I), 830X (wherein X is an amino acid other thanR), 897X (wherein X is an amino acid other than W), 1200L, 1235L, 1488X(wherein X is an amino acid other than R), 1659X (wherein X is an aminoacid other than K), 1689X (wherein X is an amino acid other than W),422D, 490N, 943L, 1002L, 1161W and 1919G. In an example, the human issuffering from or at risk of a Nav1.7-mediated disease or condition. Inan example, the method treats or reduces the risk of a Nav1.7-mediateddisease or condition in the human.

An example also provides a ligand (eg, an antibody or antibody fragment)for targeting Nav1.7 in a human, the method comprising administering tosaid human said ligand, wherein the ligand specifically binds a humanNav1.7 protein that comprises an amino acid selected from the groupconsisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein Xis an amino acid other than R), 328X (wherein X is an amino acid otherthan Y), 395K, 459X (wherein X is an amino acid other than S), 693 X(wherein X is an amino acid other than E), 767X (wherein X is an aminoacid other than I), 830X (wherein X is an amino acid other than R), 897X(wherein X is an amino acid other than W), 1200L, 1235L, 1488X (whereinX is an amino acid other than R), 1659X (wherein X is an amino acidother than K), 1689X (wherein X is an amino acid other than W), 422D,490N, 943L, 1002L, 1161W and 1919G. Said human comprises a nucleotidesequence encoding said Nav1.7 protein comprising said amino acidselected from the group consisting of 136I, 216S, 241T, 395K, 848T,858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,1627K, 277X (wherein X is an amino acid other than R), 328X (wherein Xis an amino acid other than Y), 395K, 459X (wherein X is an amino acidother than S), 693 X (wherein X is an amino acid other than E), 767X(wherein X is an amino acid other than I), 830X (wherein X is an aminoacid other than R), 897X (wherein X is an amino acid other than W),1200L, 1235L, 1488X (wherein X is an amino acid other than R), 1659X(wherein X is an amino acid other than K), 1689X (wherein X is an aminoacid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G. In anexample, the human is suffering from or at risk of a Nav1.7-mediateddisease or condition. In an example, the method treats or reduces therisk of a Nav1.7-mediated disease or condition in the human.

In an embodiment, (i) the antibody or fragment comprises a VH domainderived from the recombination of a human VH segment, a human D genesegment and a human JH segment, the human VH segment encoding theframework 1 of SEQ ID NO: 40 and wherein said human comprises a VH genesegment encoding the framework 1 of SEQ ID NO: 40, or the humanexpresses VH domains that comprise the framework 1 of SEQ ID NO: 40; andwherein (ii) said human comprises a nucleotide sequence encoding saidNav1.7 protein comprising said amino acid selected from the groupconsisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein Xis an amino acid other than R), 328X (wherein X is an amino acid otherthan Y), 395K, 459X (wherein X is an amino acid other than S), 693 X(wherein X is an amino acid other than E), 767X (wherein X is an aminoacid other than I), 830X (wherein X is an amino acid other than R), 897X(wherein X is an amino acid other than W), 1200L, 1235L, 1488X (whereinX is an amino acid other than R), 1659X (wherein X is an amino acidother than K), 1689X (wherein X is an amino acid other than W), 422D,490N, 943L, 1002L, 1161W and 1919G.

Additionally or alternatively, in an embodiment, (i) the antibody orfragment comprises a human gamma-4 heavy chain constant region thatcomprises a Leu at position 189 shown in SEQ ID NO: 73 or an Arg atposition 289 shown in SEQ ID NO: 73 and wherein said human comprises anIGHG4*01 human heavy chain constant region gene segment, or the humanexpresses antibodies comprising human gamma-4 heavy chain constantregions comprising a Leu at position 189 shown in SEQ ID NO: 73 or anArg at position 289 shown in SEQ ID NO: 73; and wherein (ii) said humancomprises a nucleotide sequence encoding said Nav1.7 protein comprisingsaid amino acid selected from the group consisting of 136I, 216S, 241T,395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T,1462V, 1464I, 1627K, 277X (wherein X is an amino acid other than R),328X (wherein X is an amino acid other than Y), 395K, 459X (wherein X isan amino acid other than S), 693 X (wherein X is an amino acid otherthan E), 767X (wherein X is an amino acid other than I), 830X (wherein Xis an amino acid other than R), 897X (wherein X is an amino acid otherthan W), 1200L, 1235L, 1488X (wherein X is an amino acid other than R),1659X (wherein X is an amino acid other than K), 1689X (wherein X is anamino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.

In an example, the ligand, antibody or fragment is for treating orreducing the risk of (or treats or reduces the risk of) pain or itching,optionally wherein the antibody is a humanized mouse or Camelid (eg,llama or camel) antibody.

In a specific embodiment, the anti-Nav1.7 ligand, antibody or fragmentalso specifically binds to another Nav selected from Nav1.1-1.9, eg, itspecifically binds to Nav1.8 or 1.9.

In a specific embodiment, the anti-Nav1.7 ligand, antibody or fragmentof present invention comprises an Fc region, wherein the Fc regioncomprises at least one non-native amino acid residue selected from thegroup consisting of 234D, 234E, 234N, 234Q, 234T, 234H, 234Y, 234I,234V, 234F, 235A, 235D, 235R, 235W, 235P, 235S, 235N, 235Q, 235T, 235H,235Y, 235I, 235V, 235F, 236E, 239D, 239E, 239N, 239Q, 239F, 239T, 239H,239Y, 240I, 240A, 240T, 240M, 241W, 241 L, 241Y, 241E, 241R. 243W, 243L243Y, 243R, 243Q, 244H, 245A, 247L, 247V, 247G, 251F, 252Y, 254T, 255L,256E, 256M, 262I, 262A, 262T, 262E, 263I, 263A, 263T, 263M, 264L, 264I,264W, 264T, 264R, 264F, 264M, 264Y, 264E, 265G, 265N, 265Q, 265Y, 265F,265V, 265I, 265L, 265H, 265T, 266I, 266A, 266T, 266M, 267Q, 267L, 268E,269H, 269Y, 269F, 269R, 270E, 280A, 284M, 292P, 292L, 296E, 296Q, 296D,296N, 296S, 296T, 296L, 296I, 296H, 269G, 297S, 297D, 297E, 298H, 298I,298T, 298F, 299I, 299L, 299A, 299S, 299V, 299H, 299F, 299E, 305I, 313F,316D, 325Q, 325L, 325I, 325D, 325E, 325A, 325T, 325V, 325H, 327G, 327W,327N, 327L, 328S, 328M, 328D, 328E, 328N, 328Q, 328F, 328I, 328V, 328T,328H, 328A, 329F, 329H, 329Q, 330K, 330G, 330T, 330C, 330L, 330Y, 330V,330I, 330F, 330R, 330H, 331G, 331A, 331L, 331M, 331F, 331W, 331K, 331Q,331E, 331S, 331V, 331I, 331C, 331Y, 331H, 331R, 331N, 331D, 331T, 332D,332S, 332W, 332F, 332E, 332N, 332Q, 332T, 332H, 332Y, 332A, 339T, 370E,370N, 378D, 392T, 396L, 416G, 419H, 421K, 440Y and 434W as numbered bythe EU index as set forth in Kabat. Optionally, the Fc region maycomprise additional and/or alternative non-native amino acid residuesknown to one skilled in the art (see, e.g., U.S. Pat. Nos. 5,624,821;6,277,375; 6,737,056; PCT Patent Publications WO 01/58957; WO 02/06919;WO 04/016750; WO 04/029207; WO 04/035752 and WO 05/040217).

The ligand, antibody or fragment according to the invention is fortreating or preventing or reducing the risk of (or treats or prevents orreduces the risk of), for example, any disease or condition disclosed inWO2011/051351, the disclosure of which diseases and conditions areincorporated herein by reference for potential inclusion in one or moreclaims herein. Guidance on obtaining and testing antibodies can also befound in that PCT application.

Further encompassed by the invention is the use of the ligand, antibodyor fragment of an in the manufacture of a medicament for use toattenuate or inhibit an Nav1.7-mediated disease or disorder in a human.Nav1.7-mediated or related disorders which are treated by the ligand,antibody or fragment of the invention include, for example, a pain oritching disease or condition.

Thus, a ligand, antibody or fragment of the invention is useful as atherapeutic agent in the treatment of a condition involving Nav1.7expression and/or activity. One embodiment, among others, is a method oftreatment comprising administering an effective amount of a ligand,antibody or fragment of the invention to a patient in need thereof,wherein functional consequences of Nav1.7 activation are decreased.Another embodiment, among others, is a method of treatment comprising(i) identifying a patient demonstrating Nav1.7 expression or activity,and (ii) administering an effective amount of a ligand, antibody orfragment of the invention to the patient, wherein a functionalconsequence of Nav1.7 activation are attenuated. An effective amountaccording to the invention is an amount that modulates (e.g. decreases)the functional consequences of Nav1.7 activation so as to modulate (e.g.decrease or lessen) the severity of at least one symptom of theparticular disease or disorder being treated, but not necessarily curethe disease or disorder. Accordingly, one embodiment of the invention isa method of treating or reducing the severity of at least one symptom ofany of the disorders referred to herein, comprising administering to apatient in need thereof an effective amount of one or more ligands,antibodies or fragments of the present invention alone or in a combinedtherapeutic regimen with another appropriate medicament known in the artor described herein such that the severity of at least one symptom ofany of the disorders is reduced. Another embodiment of the invention,among others, is a method of antagonizing at least one effect of Nav1.7comprising contacting with or administering an effective amount of oneor more ligands, antibodies or fragments of the present invention suchthat said at least one effect of Nav1.7 is antagonized, e.g. the abilityof Nav1.7 to form an ion channel, such as a sodium channel.

Tailoring Antibodies to Rarer Nav1.7 Variant Profile

As outlined herein (for example, in the context of PCSK9 in Example 1),the invention includes the possibility to tailor treatment of humansfurther by selecting antibody-based ligands with variable domains and/orconstant domains based on gene segments found in many humans of theethnic populations where the variant TOI forms are found to meet theselection criteria of the invention. This also applies mutatis mutandiswhere the TOI is human Nav1.7, as in the present example. Thus, alldisclosure herein relating to tailoring variable and/or constant domainsapply to the present example, relating to Nav1.7 and is combinable foruse in one or more claims herein.

As described in Example 1, an example is provided for ligands comprisingantibody VH domains derived from recombination of human IGHV genesegments comprising selected nucleotides at positions in the HCDR1 orFW3 where there is variability in humans (ie, where SNPs occur inhumans).

Further information is provided in Table 4, which shows variation atthese positions, as well as the variant distributions across the 1000Genomes Project database relating to many human populations.

In other embodiments, as explained more fully above, the inventionprovides for ligands which are tailored to the human recipient'sgenotype and/or phenotype based on alternative human VH gene segments,or on Vκ, Vλ or constant region gene segments (see further Table 9 forrepresentative variants).

Further examples, therefore are:—

(i) wherein the ligand comprises a VH domain derived from therecombination of a human VH segment (eg, human VH3-23*04), a human Dgene segment and a human JH segment, the human VH segment encoding theframework 1 of SEQ ID NO: 40 and wherein said human comprises a VH genesegment encoding the framework 1 of SEQ ID NO: 40, or the humanexpresses VH domains that comprise the framework 1 of SEQ ID NO: 40.(ii) wherein the ligand comprises a VH domain derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment, and wherein said human comprises a IGHV3-7*01 VHgene segment or the human expresses VH domains derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JR segment.(iii) wherein the ligand comprises a Vκ domain derived from therecombination of human Vκ segment IGKV1-12*01 and a human Jκ segment,and wherein said human comprises a IGKV1-12*01 Vκ gene segment or thehuman expresses Vκ domains derived from the recombination of human Vκsegment IGKV1-12*01 and a human Jκ segment.(iv) wherein the ligand comprises a Vκ domain derived from therecombination of a human Vκ segment and a human Jκ segment, the human Vκsegment encoding (i) a CDR3 comprising a Pro at position 7 shown in SEQID NO: 36 and wherein said human comprises a Vκ gene segment encoding aCDR3 comprising a Pro at position 7 shown in SEQ ID NO: 36, or the humanexpresses Vκ domains that comprise a CDR3 comprising a Pro at position 7shown in SEQ ID NO: 36; or (ii) a FW3 comprising a Ser at position 15shown in SEQ ID NO: 38 and wherein said human comprises a Vκ genesegment encoding a FW3 comprising a Ser at position 15 shown in SEQ IDNO: 38 or the human expresses Vκ domains that comprise a FW3 comprisinga Ser at position 15 shown in SEQ ID NO: 38.(v) wherein the ligand comprises a human gamma-1 heavy chain constantregion that comprises an Asp at position 204 shown in SEQ ID NO: 4 or aLeu at position 206 shown in SEQ ID NO: 4 and wherein said humancomprises (i) an IGHG1*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-1heavy chain constant regions comprising an Asp at position 204 shown inSEQ ID NO: 4 or a Leu at position 206 shown in SEQ ID NO: 4.(vi) wherein the ligand comprises a human gamma-2 heavy chain constantregion that comprises an amino acid selected from the group consistingof a Pro at position 72 shown in SEQ ID NO: 6, an Asn at position 75shown in SEQ ID NO: 6, a Phe at position 76 shown in SEQ ID NO: 6, a Valat position 161 shown in SEQ ID NO: 6 and an Ala at position 257 shownin SEQ ID NO: 6 and wherein said human comprises (i) an IGHG2*01 humanheavy chain constant region gene segment, or the human expressesantibodies comprising human gamma-2 heavy chain constant regionscomprising said selected Pro at position 72 shown in SEQ ID NO: 6, Asnat position 75 shown in SEQ ID NO: 6, Phe at position 76 shown in SEQ IDNO: 6, Val at position 161 shown in SEQ ID NO: 6 or Ala at position 257shown in SEQ ID NO: 6.(vii) wherein the ligand comprises a human kappa chain constant regionthat comprises a Val at position 84 shown in SEQ ID NO: 16 or a Cys atposition 87 shown in SEQ ID NO: 16 and wherein said human comprises (i)an IGKC1*01 human kappa chain constant region gene segment, or the humanexpresses antibodies comprising human kappa chain constant regionscomprising a Val corresponding to position 84 shown in SEQ ID NO: 16 ora Cys at position 87 shown in SEQ ID NO: 16.(viii) wherein the ligand comprises a human IGLC1*01 lambda chainconstant region and wherein said human comprises (i) a human IGLC1*01lambda chain constant region gene segment, or the human expressesantibodies comprising human IGLC1*01 lambda chain constant regions.(ix) wherein the ligand comprises a human gamma-4 heavy chain constantregion that comprises a Leu at position 189 shown in SEQ ID NO: 73 or anArg at position 289 shown in SEQ ID NO: 73 and wherein said humancomprises (i) an IGHG4*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-4heavy chain constant regions comprising a Leu at position 189 shown inSEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73.(x) wherein the ligand comprises a human gamma-3 heavy chain constantregion encoded by a first human IGHG3 (eg, IGHG3*01) constant regiongene segment and wherein said human comprises (i) said first constantregion gene segment (eg, an IGHG3*01), or the human expresses antibodiescomprising human gamma-3 heavy chain constant regions encoded by saidfirst human IGHG3 (eg, IGHG3*01) constant region gene segment.(xi) wherein the ligand comprises a human epsilon heavy chain constantregion encoded by a first human epsilon heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human epsilonheavy chain constant regions encoded by said first constant region genesegment.(xii) wherein the ligand comprises a human mu heavy chain constantregion encoded by a first human mu heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human muheavy chain constant regions encoded by said first constant region genesegment.(xiii) wherein the ligand comprises a human alpha heavy chain constantregion encoded by a first human alpha heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human alphaheavy chain constant regions encoded by said first constant region genesegment.(xiv) wherein the ligand comprises a human delta heavy chain constantregion encoded by a first human delta heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human deltaheavy chain constant regions encoded by said first constant region genesegment.(xv) wherein the ligand comprises a human kappa light chain constantregion encoded by a first human kappa light chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human kappalight chain constant regions encoded by said first constant region genesegment.(xvi) wherein the ligand comprises a human lambda light chain constantregion encoded by a first human lambda light chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human lambdalight chain constant regions encoded by said first constant region genesegment.

These examples, although written in the context of the present Nav1.7example, are applicable to the invention as it relates to any other TOIherein and thus can be combined and used in claims herein relating toany TOI. In any of these example, the ligand is optionally an antibody,eg, a human or humanised antibody (eg, a humanised mouse, rat or Camelidantibody).

For ADCC efficacy for human constant regions is: IgG1≧IgG3>>IgG4≧IgG2

For CDC efficacy for human constant regions is: IgG3≧IgGl>>IgG2≈IgG4

Thus, it may be advantageous for Nav1.7 ligands, for the ligand tocomprise a gamma-4 or gamma-2 constant region (eg, as per the examplesabove). For example, the gamma-4 is an IgG4PE (ie, a gamma-4 constantregion with 228Pro and 235Glu). For example the gamma-2 is an IgG2Δa.

For example, as per example (ix), the inventor identified thepossibility of addressing IGH-gamma-4 variation and identified utilityfor variations 189L and 289R individually or in combination, since theseresidues are part of the CH3 domain, and as such they form part ofantibody Fc regions. Thus, matching of these CH3 variations with thepatient is especially beneficial for reasons as discussed above. Thus,in this example the ligand of the invention comprises or consists of anantibody that comprises a human gamma-4 heavy chain constant region thatcomprises a Leu corresponding to position 189 of SEQ ID NO: 73 or an Argcorresponding to position 289 of SEQ ID NO: 73 and wherein the genome ofthe human comprises a gamma-4 heavy chain constant region nucleotidesequence that encodes such a Leu and/or Arg or the human expressesantibodies comprising human gamma-4 constant regions comprising such aLeu and/or Arg.

Determination of Specific Binding of Ligands of the Invention to NAV1.7Variants

The specific binding of ligands of the invention to Nav1.7 variants canbe performed using the SPR method described in Example 1.

Embodiments are provided as follows:—

Methods with VH Tailoring

-   1. A method of treating or reducing the risk of a Nav1.7-mediated    disease or condition in a human in need thereof, the method    comprising administering to said human a ligand (eg, an antibody or    antibody fragment) that specifically binds a human Nav1.7 protein    that comprises an amino acid selected from the group consisting of    136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,    1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an    amino acid other than R), 328X (wherein X is an amino acid other    than Y), 395K, 459X (wherein X is an amino acid other than S), 693 X    (wherein X is an amino acid other than E), 767X (wherein X is an    amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G;    -   wherein (i) the ligand comprises a VH domain derived from the        recombination of a human VH segment, a human D gene segment and        a human JH segment, the human VH segment encoding the framework        1 of SEQ ID NO: 40 and wherein said human comprises a VH gene        segment encoding the framework 1 of SEQ ID NO: 40, or the human        expresses VH domains that comprise the framework 1 of SEQ ID NO:        40; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an alternative, clause 1 provides:—    -   A method of targeting Nav1.7 in a human, the method comprising        administering to said human a ligand (eg, an antibody or        antibody fragment) that specifically binds a human Nav1.7        protein that comprises an amino acid selected from the group        consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P,        1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K,        277X (wherein X is an amino acid other than R), 328X (wherein X        is an amino acid other than Y), 395K, 459X (wherein X is an        amino acid other than S), 693 X (wherein X is an amino acid        other than E), 767X (wherein X is an amino acid other than I),        830X (wherein X is an amino acid other than R), 897X (wherein X        is an amino acid other than W), 1200L, 1235L, 1488X (wherein X        is an amino acid other than R), 1659X (wherein X is an amino        acid other than K), 1689X (wherein X is an amino acid other than        W), 422D, 490N, 943L, 1002L, 1161W and 1919G;    -   wherein (i) the ligand comprises a VH domain derived from the        recombination of a human VH segment, a human D gene segment and        a human JH segment, the human VH segment encoding the framework        1 of SEQ ID NO: 40 and wherein said human comprises a VH gene        segment encoding the framework 1 of SEQ ID NO: 40, or the human        expresses VH domains that comprise the framework 1 of SEQ ID NO:        40; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an example, the human is suffering from or at risk of a        Nav1.7-mediated disease or condition.    -   In an example, the method treats or reduces the risk of a        Nav1.7-mediated disease or condition in the human.-   2. The method of any preceding clause, wherein said amino acid is    selected from the group consisting of any one of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P and 1449V; optionally wherein said    disease or condition is a pain disease or condition.-   3. The method of any preceding clause, wherein said amino acid is    selected from the group consisting of 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I and 1627K; optionally wherein said disease or    condition is a pain disease or condition.-   4. The method of any preceding clause, wherein said amino acid is    selected from the group consisting of 277X (wherein X is an amino    acid other than R), 328X (wherein X is an amino acid other than Y),    395K, 459X (wherein X is an amino acid other than S), 693 X (wherein    X is an amino acid other than E), 767X (wherein X is an amino acid    other than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K) and 1689X (wherein X is an amino acid other    than W); optionally wherein said disease or condition is a pain    disease or condition.-   5. The method of any preceding clause, wherein the VH gene segment    comprised by said human is a germline VH gene segment.-   6. The method of any preceding clause comprising, before said    administering, selecting a human comprising said nucleotide sequence    of (ii), wherein the human is the human of clause 1.-   7. The method of any preceding clause, wherein the human has been    determined to comprise the nucleotide sequence that encodes an    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G    and/or an Nav1.7 protein comprising said amino acid selected from    the group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,    863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K,    277X (wherein X is an amino acid other than R), 328X (wherein X is    an amino acid other than Y), 395K, 459X (wherein X is an amino acid    other than S), 693 X (wherein X is an amino acid other than E), 767X    (wherein X is an amino acid other than I), 830X (wherein X is an    amino acid other than R), 897X (wherein X is an amino acid other    than W), 1200L, 1235L, 1488X (wherein X is an amino acid other than    R), 1659X (wherein X is an amino acid other than K), 1689X (wherein    X is an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and    1919G.-   8. The method of any preceding clause, comprising the step of    determining that the human comprises (a) the nucleotide sequence    that encodes an Nav1.7 protein comprising said amino acid selected    from the group consisting of 136I, 216S, 241T, 395K, 848T, 858H,    858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,    1627K, 277X (wherein X is an amino acid other than R), 328X (wherein    X is an amino acid other than Y), 395K, 459X (wherein X is an amino    acid other than S), 693 X (wherein X is an amino acid other than E),    767X (wherein X is an amino acid other than I), 830X (wherein X is    an amino acid other than R), 897X (wherein X is an amino acid other    than W), 1200L, 1235L, 1488X (wherein X is an amino acid other than    R), 1659X (wherein X is an amino acid other than K), 1689X (wherein    X is an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and    1919G and/or (b) an Nav1.7 protein comprising said mutation said    amino acid selected from the group consisting of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acid other    than R), 328X (wherein X is an amino acid other than Y), 395K, 459X    (wherein X is an amino acid other than S), 693 X (wherein X is an    amino acid other than E), 767X (wherein X is an amino acid other    than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K), 1689X (wherein X is an amino acid other    than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, optionally,    wherein the determining step is performed before administration of    the antibody to the human.-   9. The method of clause 8, wherein the step of determining comprises    assaying a biological sample from the human for a nucleotide    sequence encoding a Nav1.7 protein comprising said amino acid    selected from the group consisting of 136I, 216S, 241T, 395K, 848T,    858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,    1464I, 1627K, 277X (wherein X is an amino acid other than R), 328X    (wherein X is an amino acid other than Y), 395K, 459X (wherein X is    an amino acid other than S), 693 X (wherein X is an amino acid other    than E), 767X (wherein X is an amino acid other than I), 830X    (wherein X is an amino acid other than R), 897X (wherein X is an    amino acid other than W), 1200L, 1235L, 1488X (wherein X is an amino    acid other than R), 1659X (wherein X is an amino acid other than K),    1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,    1002L, 1161W and 1919G.-   10. The method of clause 9, wherein the assaying comprises    -   contacting the biological sample with at least one        oligonucleotide probe comprising a sequence of at least 10        contiguous nucleotides of a nucleotide sequence encoding an        Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises a        nucleotide sequence encoding said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, thereby        forming a complex when at least one nucleotide sequence encoding        the Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G is        present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the Nav1.7 protein comprising said amino acid selected        from the group consisting of 136I, 216S, 241T, 395K, 848T, 858H,        858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,        1464I, 1627K, 277X (wherein X is an amino acid other than R),        328X (wherein X is an amino acid other than Y), 395K, 459X        (wherein X is an amino acid other than S), 693 X (wherein X is        an amino acid other than E), 767X (wherein X is an amino acid        other than I), 830X (wherein X is an amino acid other than R),        897X (wherein X is an amino acid other than W), 1200L, 1235L,        1488X (wherein X is an amino acid other than R), 1659X (wherein        X is an amino acid other than K), 1689X (wherein X is an amino        acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   11. The method of clause 9, wherein the assaying comprises nucleic    acid amplification and optionally one or more methods selected from    sequencing, next generation sequencing, nucleic acid hybridization,    and allele-specific amplification and/or wherein the assaying is    performed in a multiplex format.-   12. The method of clause 9 or 11, wherein said biological sample    comprises serum, blood, faeces, tissue, a cell, urine and/or saliva    of said human.-   13. The method of any preceding clause, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G,    optionally, wherein said human is further indicated as comprising    the nucleotide sequence of SEQ ID NO: 76, or said human is indicated    as homozygous for a nucleotide sequence encoding the Nav1.7 protein    comprising said amino acid selected from the group consisting of    136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,    1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an    amino acid other than R), 328X (wherein X is an amino acid other    than Y), 395K, 459X (wherein X is an amino acid other than S), 693 X    (wherein X is an amino acid other than E), 767X (wherein X is an    amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   14. The method of any preceding clause, wherein said human is or has    been further determined to be substantially resistant to a pain or    itching treatment.-   15. The method of any preceding clause, wherein said human is    receiving or has received a pain or itching treatment or has reduced    responsiveness to a pain or itching treatment.-   16. The method of any preceding clause, wherein said disease or    condition is a pain or itching disease or condition.-   17. The method of any preceding clause, wherein said disease or    condition is a channelopathy or associated with a channelopathy; or    is selected from the group consisting of primary erythermalgia (PE),    paroxysmal extreme pain disorder (PEPD) and channelopathy-associated    insensitivity to pain (CIP).-   18. The method of any preceding clause, wherein said human has been    diagnosed with at least one condition recited in claim 16 or 17.-   19. The method of any preceding clause, wherein said antibody or    antibody fragment treats or reduces the risk in said human of a    condition recited in claim 16 or 17.-   20. The method of any preceding clause, wherein the nucleotide    sequence comprises one or more SNPs selected from the group    consisting of rs6746030, rs3750904, rs58022607, rs4369876,    rs13402180 and rs12478318.-   21. The method of any preceding clause, wherein said ligand (eg,    antibody or antibody fragment) is administered by inhaled,    intravenous or subcutaneous administration and/or is comprised in an    inhalable or injectable preparation.-   22. The method of any preceding clause, wherein the VH domain    comprises the amino acid sequence of SEQ ID NO: 69.

Preferably herein the Nav1.7 mutation is 1161W (also known as 1150W insome publications, eg, Reimann et al (Proc Natl Acad Sci USA. 2010 Mar.16; 107(11):5148-53. doi: 10.1073/pnas.0913181107. Epub 2010 Mar. 8;“Pain perception is altered by a nucleotide polymorphism in SCN9A”;Reimann F et al). This describes the correlation of 1150W (ie, 1161W)with increased pain perception (lower threshold) in normal humans.

Ligands with VH Tailoring

-   1. A ligand (eg, an antibody or antibody fragment) for use in a    method of treating or reducing the risk of a Nav1.7-mediated disease    or condition (eg, asthma) in a human in need thereof, wherein the    ligand specifically binds a human Nav1.7 protein that comprises an    amino acid selected from the group consisting of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acid other    than R), 328X (wherein X is an amino acid other than Y), 395K, 459X    (wherein X is an amino acid other than S), 693 X (wherein X is an    amino acid other than E), 767X (wherein X is an amino acid other    than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K), 1689X (wherein X is an amino acid other    than W), 422D, 490N, 943L, 1002L, 1161W and 1919G;    -   wherein (i) the ligand comprises a VH domain derived from the        recombination of a human VH segment, a human D gene segment and        a human JH segment, the human VH segment encoding the framework        1 of SEQ ID NO: 40 and wherein said human comprises a VH gene        segment encoding the framework 1 of SEQ ID NO: 40, or the human        expresses VH domains that comprise the framework 1 of SEQ ID NO:        40; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an alternative, paragraph 1 provides:—    -   A ligand (eg, an antibody or antibody fragment) for use in a        method of targeting Nav1.7 in a human, wherein the ligand        specifically binds a human Nav1.7 protein that comprises an        amino acid selected from the group consisting of 136I, 216S,        241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D,        1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino        acid other than R), 328X (wherein X is an amino acid other than        Y), 395K, 459X (wherein X is an amino acid other than S), 693 X        (wherein X is an amino acid other than E), 767X (wherein X is an        amino acid other than I), 830X (wherein X is an amino acid other        than R), 897X (wherein X is an amino acid other than W), 1200L,        1235L, 1488X (wherein X is an amino acid other than R), 1659X        (wherein X is an amino acid other than K), 1689X (wherein X is        an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and        1919G;    -   wherein (i) the ligand comprises a VH domain derived from the        recombination of a human VH segment, a human D gene segment and        a human JH segment, the human VH segment encoding the framework        1 of SEQ ID NO: 40 and wherein said human comprises a VH gene        segment encoding the framework 1 of SEQ ID NO: 40, or the human        expresses VH domains that comprise the framework 1 of SEQ ID NO:        40; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an example, the human is suffering from or at risk of a        Nav1.7-mediated disease or condition.    -   In an example, the method treats or reduces the risk of a        Nav1.7-mediated disease or condition in the human.-   2. The ligand of any preceding clause, wherein said amino acid is    selected from the group consisting of any one of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P and 1449V; optionally wherein said    disease or condition is a pain disease or condition.-   3. The ligand of any preceding clause, wherein said amino acid is    selected from the group consisting of 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I and 1627K; optionally wherein said disease or    condition is a pain disease or condition.-   4. The ligand of any preceding clause, wherein said amino acid is    selected from the group consisting of 277X (wherein X is an amino    acid other than R), 328X (wherein X is an amino acid other than Y),    395K, 459X (wherein X is an amino acid other than S), 693 X (wherein    X is an amino acid other than E), 767X (wherein X is an amino acid    other than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K) and 1689X (wherein X is an amino acid other    than W); optionally wherein said disease or condition is a pain    disease or condition.-   5. The ligand of any preceding clause, wherein the VH gene segment    comprised by said human is a germline VH gene segment.-   6. The ligand of any preceding clause said method comprising, before    said administering, selecting a human comprising said nucleotide    sequence of (ii), wherein the human is the human of clause 1.-   7. The ligand of any preceding clause, wherein the human has been    determined to comprise the nucleotide sequence that encodes an    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G    and/or an Nav1.7 protein comprising said amino acid selected from    the group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,    863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K,    277X (wherein X is an amino acid other than R), 328X (wherein X is    an amino acid other than Y), 395K, 459X (wherein X is an amino acid    other than S), 693 X (wherein X is an amino acid other than E), 767X    (wherein X is an amino acid other than I), 830X (wherein X is an    amino acid other than R), 897X (wherein X is an amino acid other    than W), 1200L, 1235L, 1488X (wherein X is an amino acid other than    R), 1659X (wherein X is an amino acid other than K), 1689X (wherein    X is an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and    1919G.-   8. The ligand of any preceding clause, said method comprising the    step of determining that the human comprises (a) the nucleotide    sequence that encodes an Nav1.7 protein comprising said amino acid    selected from the group consisting of 136I, 216S, 241T, 395K, 848T,    858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,    1464I, 1627K, 277X (wherein X is an amino acid other than R), 328X    (wherein X is an amino acid other than Y), 395K, 459X (wherein X is    an amino acid other than S), 693 X (wherein X is an amino acid other    than E), 767X (wherein X is an amino acid other than I), 830X    (wherein X is an amino acid other than R), 897X (wherein X is an    amino acid other than W), 1200L, 1235L, 1488X (wherein X is an amino    acid other than R), 1659X (wherein X is an amino acid other than K),    1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,    1002L, 1161W and 1919G and/or (b) an Nav1.7 protein comprising said    mutation said amino acid selected from the group consisting of 136I,    216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D,    1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acid    other than R), 328X (wherein X is an amino acid other than Y), 395K,    459X (wherein X is an amino acid other than S), 693 X (wherein X is    an amino acid other than E), 767X (wherein X is an amino acid other    than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K), 1689X (wherein X is an amino acid other    than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, optionally,    wherein the determining step is performed before administration of    the antibody to the human.-   9. The ligand of clause 8, wherein the step of determining comprises    assaying a biological sample from the human for a nucleotide    sequence encoding a Nav1.7 protein comprising said amino acid    selected from the group consisting of 136I, 216S, 241T, 395K, 848T,    858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,    1464I, 1627K, 277X (wherein X is an amino acid other than R), 328X    (wherein X is an amino acid other than Y), 395K, 459X (wherein X is    an amino acid other than S), 693 X (wherein X is an amino acid other    than E), 767X (wherein X is an amino acid other than I), 830X    (wherein X is an amino acid other than R), 897X (wherein X is an    amino acid other than W), 1200L, 1235L, 1488X (wherein X is an amino    acid other than R), 1659X (wherein X is an amino acid other than K),    1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,    1002L, 1161W and 1919G.-   10. The ligand of clause 9, wherein the assaying comprises    -   contacting the biological sample with at least one        oligonucleotide probe comprising a sequence of at least 10        contiguous nucleotides of a nucleotide sequence encoding an        Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises a        nucleotide sequence encoding said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, thereby        forming a complex when at least one nucleotide sequence encoding        the Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G is        present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the Nav1.7 protein comprising said amino acid selected        from the group consisting of 136I, 216S, 241T, 395K, 848T, 858H,        858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,        1464I, 1627K, 277X (wherein X is an amino acid other than R),        328X (wherein X is an amino acid other than Y), 395K, 459X        (wherein X is an amino acid other than S), 693 X (wherein X is        an amino acid other than E), 767X (wherein X is an amino acid        other than I), 830X (wherein X is an amino acid other than R),        897X (wherein X is an amino acid other than W), 1200L, 1235L,        1488X (wherein X is an amino acid other than R), 1659X (wherein        X is an amino acid other than K), 1689X (wherein X is an amino        acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   11. The ligand of clause 9, wherein the assaying comprises nucleic    acid amplification and optionally one or more methods selected from    sequencing, next generation sequencing, nucleic acid hybridization,    and allele-specific amplification and/or wherein the assaying is    performed in a multiplex format.-   12. The ligand of clause 9 or 11, wherein said biological sample    comprises serum, blood, faeces, tissue, a cell, urine and/or saliva    of said human.-   13. The ligand of any preceding clause, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G,    optionally, wherein said human is further indicated as comprising    the nucleotide sequence of SEQ ID NO: 76, or said human is indicated    as homozygous for a nucleotide sequence encoding the Nav1.7 protein    comprising said amino acid selected from the group consisting of    136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,    1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an    amino acid other than R), 328X (wherein X is an amino acid other    than Y), 395K, 459X (wherein X is an amino acid other than S), 693 X    (wherein X is an amino acid other than E), 767X (wherein X is an    amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   14. The ligand of any preceding clause, wherein said human is or has    been further determined to be substantially resistant to a pain or    itching treatment.-   15. The ligand of any preceding clause, wherein said human is    receiving or has received a pain or itching treatment or has reduced    responsiveness to a pain or itching treatment.-   16. The ligand of any preceding clause, wherein said disease or    condition is a pain or itching disease or condition.-   17. The ligand of any preceding clause, wherein said disease or    condition is a channelopathy or associated with a channelopathy; or    is selected from the group consisting of primary erythermalgia (PE),    paroxysmal extreme pain disorder (PEPD) and channelopathy-associated    insensitivity to pain (CIP).-   18. The ligand of any preceding clause, wherein said human has been    diagnosed with at least one condition recited in claim 16 or 17.-   19. The ligand of any preceding clause, wherein said antibody or    antibody fragment treats or reduces the risk in said human of a    condition recited in claim 16 or 17.-   20. The ligand of any preceding clause, wherein the nucleotide    sequence comprises one or more SNPs selected from the group    consisting of rs6746030, rs3750904, rs58022607, rs4369876,    rs13402180 and rs12478318.-   21. The ligand of any preceding clause, wherein said ligand (eg,    antibody or antibody fragment) is for inhaled, intravenous or    subcutaneous administration and/or is comprised in an inhalable or    injectable preparation.-   22. The ligand of any preceding clause, wherein the VH domain    comprises the amino acid sequence of SEQ ID NO: 69.

Methods with Gamma-4 Constant Region Tailoring

-   1. A method of treating or reducing the risk of a Nav1.7-mediated    disease or condition in a human in need thereof, the method    comprising administering to said human a ligand (eg, an antibody or    antibody fragment) that specifically binds a human Nav1.7 protein    that comprises an amino acid selected from the group consisting of    136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,    1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an    amino acid other than R), 328X (wherein X is an amino acid other    than Y), 395K, 459X (wherein X is an amino acid other than S), 693 X    (wherein X is an amino acid other than E), 767X (wherein X is an    amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G;    -   wherein (i) the ligand comprises a human gamma-4 heavy chain        constant region that comprises a Leu at position 189 shown in        SEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73        and wherein said human comprises (i) an IGHG4*01 human heavy        chain constant region gene segment, or the human expresses        antibodies comprising human gamma-4 heavy chain constant regions        comprising a Leu at position 189 shown in SEQ ID NO: 73 or an        Arg at position 289 shown in SEQ ID NO: 73; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an alternative, clause 1 provides:—    -   A method of targeting Nav1.7 in a human, the method comprising        administering to said human a ligand (eg, an antibody or        antibody fragment) that specifically binds a human Nav1.7        protein that comprises an amino acid selected from the group        consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P,        1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K,        277X (wherein X is an amino acid other than R), 328X (wherein X        is an amino acid other than Y), 395K, 459X (wherein X is an        amino acid other than S), 693 X (wherein X is an amino acid        other than E), 767X (wherein X is an amino acid other than I),        830X (wherein X is an amino acid other than R), 897X (wherein X        is an amino acid other than W), 1200L, 1235L, 1488X (wherein X        is an amino acid other than R), 1659X (wherein X is an amino        acid other than K), 1689X (wherein X is an amino acid other than        W), 422D, 490N, 943L, 1002L, 1161W and 1919G;    -   wherein (i) the ligand comprises a human gamma-4 heavy chain        constant region that comprises a Leu at position 189 shown in        SEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73        and wherein said human comprises (i) an IGHG4*01 human heavy        chain constant region gene segment, or the human expresses        antibodies comprising human gamma-4 heavy chain constant regions        comprising a Leu at position 189 shown in SEQ ID NO: 73 or an        Arg at position 289 shown in SEQ ID NO: 73; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an example, the human is suffering from or at risk of a        Nav1.7-mediated disease or condition.    -   In an example, the method treats or reduces the risk of a        Nav1.7-mediated disease or condition in the human.-   2. The method of any preceding clause, wherein said amino acid is    selected from the group consisting of any one of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P and 1449V; optionally wherein said    disease or condition is a pain disease or condition.-   3. The method of any preceding clause, wherein said amino acid is    selected from the group consisting of 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I and 1627K; optionally wherein said disease or    condition is a pain disease or condition.-   4. The method of any preceding clause, wherein said amino acid is    selected from the group consisting of 277X (wherein X is an amino    acid other than R), 328X (wherein X is an amino acid other than Y),    395K, 459X (wherein X is an amino acid other than S), 693 X (wherein    X is an amino acid other than E), 767X (wherein X is an amino acid    other than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K) and 1689X (wherein X is an amino acid other    than W); optionally wherein said disease or condition is a pain    disease or condition.-   5. The method of any preceding clause, wherein the constant region    gene segment comprised by said human is a germline gene segment.-   6. The method of any preceding clause comprising, before said    administering, selecting a human comprising said nucleotide sequence    of (ii), wherein the human is the human of clause 1.-   7. The method of any preceding clause, wherein the human has been    determined to comprise the nucleotide sequence that encodes an    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G    and/or an Nav1.7 protein comprising said amino acid selected from    the group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,    863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K,    277X (wherein X is an amino acid other than R), 328X (wherein X is    an amino acid other than Y), 395K, 459X (wherein X is an amino acid    other than S), 693 X (wherein X is an amino acid other than E), 767X    (wherein X is an amino acid other than I), 830X (wherein X is an    amino acid other than R), 897X (wherein X is an amino acid other    than W), 1200L, 1235L, 1488X (wherein X is an amino acid other than    R), 1659X (wherein X is an amino acid other than K), 1689X (wherein    X is an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and    1919G.-   8. The method of any preceding clause, comprising the step of    determining that the human comprises (a) the nucleotide sequence    that encodes an Nav1.7 protein comprising said amino acid selected    from the group consisting of 136I, 216S, 241T, 395K, 848T, 858H,    858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,    1627K, 277X (wherein X is an amino acid other than R), 328X (wherein    X is an amino acid other than Y), 395K, 459X (wherein X is an amino    acid other than S), 693 X (wherein X is an amino acid other than E),    767X (wherein X is an amino acid other than I), 830X (wherein X is    an amino acid other than R), 897X (wherein X is an amino acid other    than W), 1200L, 1235L, 1488X (wherein X is an amino acid other than    R), 1659X (wherein X is an amino acid other than K), 1689X (wherein    X is an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and    1919G and/or (b) an Nav1.7 protein comprising said mutation said    amino acid selected from the group consisting of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acid other    than R), 328X (wherein X is an amino acid other than Y), 395K, 459X    (wherein X is an amino acid other than S), 693 X (wherein X is an    amino acid other than E), 767X (wherein X is an amino acid other    than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K), 1689X (wherein X is an amino acid other    than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, optionally,    wherein the determining step is performed before administration of    the antibody to the human.-   9. The method of clause 8, wherein the step of determining comprises    assaying a biological sample from the human for a nucleotide    sequence encoding a Nav1.7 protein comprising said amino acid    selected from the group consisting of 136I, 216S, 241T, 395K, 848T,    858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,    1464I, 1627K, 277X (wherein X is an amino acid other than R), 328X    (wherein X is an amino acid other than Y), 395K, 459X (wherein X is    an amino acid other than S), 693 X (wherein X is an amino acid other    than E), 767X (wherein X is an amino acid other than I), 830X    (wherein X is an amino acid other than R), 897X (wherein X is an    amino acid other than W), 1200L, 1235L, 1488X (wherein X is an amino    acid other than R), 1659X (wherein X is an amino acid other than K),    1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,    1002L, 1161W and 1919G.-   10. The method of clause 9, wherein the assaying comprises    -   contacting the biological sample with at least one        oligonucleotide probe comprising a sequence of at least 10        contiguous nucleotides of a nucleotide sequence encoding an        Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises a        nucleotide sequence encoding said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, thereby        forming a complex when at least one nucleotide sequence encoding        the Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G is        present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the Nav1.7 protein comprising said amino acid selected        from the group consisting of 136I, 216S, 241T, 395K, 848T, 858H,        858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,        1464I, 1627K, 277X (wherein X is an amino acid other than R),        328X (wherein X is an amino acid other than Y), 395K, 459X        (wherein X is an amino acid other than S), 693 X (wherein X is        an amino acid other than E), 767X (wherein X is an amino acid        other than I), 830X (wherein X is an amino acid other than R),        897X (wherein X is an amino acid other than W), 1200L, 1235L,        1488X (wherein X is an amino acid other than R), 1659X (wherein        X is an amino acid other than K), 1689X (wherein X is an amino        acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   11. The method of clause 9, wherein the assaying comprises nucleic    acid amplification and optionally one or more methods selected from    sequencing, next generation sequencing, nucleic acid hybridization,    and allele-specific amplification and/or wherein the assaying is    performed in a multiplex format.-   12. The method of clause 9 or 11, wherein said biological sample    comprises serum, blood, faeces, tissue, a cell, urine and/or saliva    of said human.-   13. The method of any preceding clause, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G,    optionally, wherein said human is further indicated as comprising    the nucleotide sequence of SEQ ID NO: 76, or said human is indicated    as homozygous for a nucleotide sequence encoding the Nav1.7 protein    comprising said amino acid selected from the group consisting of    136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,    1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an    amino acid other than R), 328X (wherein X is an amino acid other    than Y), 395K, 459X (wherein X is an amino acid other than S), 693 X    (wherein X is an amino acid other than E), 767X (wherein X is an    amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   14. The method of any preceding clause, wherein said human is or has    been further determined to be substantially resistant to a pain or    itching treatment.-   15. The method of any preceding clause, wherein said human is    receiving or has received a pain or itching treatment or has reduced    responsiveness to a pain or itching treatment.-   16. The method of any preceding clause, wherein said disease or    condition is a pain or itching disease or condition.-   17. The method of any preceding clause, wherein said disease or    condition is a channelopathy or associated with a channelopathy; or    is selected from the group consisting of primary erythermalgia (PE),    paroxysmal extreme pain disorder (PEPD) and channelopathy-associated    insensitivity to pain (CIP).-   18. The method of any preceding clause, wherein said human has been    diagnosed with at least one condition recited in claim 16 or 17.-   19. The method of any preceding clause, wherein said antibody or    antibody fragment treats or reduces the risk in said human of a    condition recited in claim 16 or 17.-   20. The method of any preceding clause, wherein the nucleotide    sequence comprises one or more SNPs selected from the group    consisting of rs6746030, rs3750904, rs58022607, rs4369876,    rs13402180 and rs12478318.-   21. The method of any preceding clause, wherein said ligand (eg,    antibody or antibody fragment) is administered by inhaled,    intravenous or subcutaneous administration and/or is comprised in an    inhalable or injectable preparation.-   22. The method of any preceding clause, wherein the human gamma-4    heavy chain constant region of the ligand comprises the amino acid    sequence of SEQ ID NO: 73 or an ADCC inactivated version thereof.-   23. The method of any preceding clause, wherein the human gamma-4    heavy chain constant region comprises 228P and 235E.

Ligands with Gamma-4 Constant Region Tailoring

-   1. A ligand (eg, an antibody or antibody fragment) for use in a    method of treating or reducing the risk of a Nav1.7-mediated disease    or condition (eg, pain) in a human in need thereof, wherein the    ligand specifically binds a human Nav1.7 protein that comprises an    amino acid selected from the group consisting of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acid other    than R), 328X (wherein X is an amino acid other than Y), 395K, 459X    (wherein X is an amino acid other than S), 693 X (wherein X is an    amino acid other than E), 767X (wherein X is an amino acid other    than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K), 1689X (wherein X is an amino acid other    than W), 422D, 490N, 943L, 1002L, 1161W and 1919G;    -   wherein (i) the ligand comprises a human gamma-4 heavy chain        constant region that comprises a Leu at position 189 shown in        SEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73        and wherein said human comprises (i) an IGHG4*01 human heavy        chain constant region gene segment, or the human expresses        antibodies comprising human gamma-4 heavy chain constant regions        comprising a Leu at position 189 shown in SEQ ID NO: 73 or an        Arg at position 289 shown in SEQ ID NO: 73; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an alternative, paragraph 1 provides:—    -   A ligand (eg, an antibody or antibody fragment) for use in a        method of targeting Nav1.7 in a human, wherein the ligand        specifically binds a human Nav1.7 protein that comprises an        amino acid selected from the group consisting of 136I, 216S,        241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D,        1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino        acid other than R), 328X (wherein X is an amino acid other than        Y), 395K, 459X (wherein X is an amino acid other than S), 693 X        (wherein X is an amino acid other than E), 767X (wherein X is an        amino acid other than I), 830X (wherein X is an amino acid other        than R), 897X (wherein X is an amino acid other than W), 1200L,        1235L, 1488X (wherein X is an amino acid other than R), 1659X        (wherein X is an amino acid other than K), 1689X (wherein X is        an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and        1919G;    -   wherein (i) the ligand comprises a human gamma-4 heavy chain        constant region that comprises a Leu at position 189 shown in        SEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73        and wherein said human comprises (i) an IGHG4*01 human heavy        chain constant region gene segment, or the human expresses        antibodies comprising human gamma-4 heavy chain constant regions        comprising a Leu at position 189 shown in SEQ ID NO: 73 or an        Arg at position 289 shown in SEQ ID NO: 73; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an example, the human is suffering from or at risk of a        Nav1.7-mediated disease or condition.    -   In an example, the method treats or reduces the risk of a        Nav1.7-mediated disease or condition in the human.-   2. The ligand of any preceding clause, wherein said amino acid is    selected from the group consisting of any one of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P and 1449V; optionally wherein said    disease or condition is a pain disease or condition.-   3. The ligand of any preceding clause, wherein said amino acid is    selected from the group consisting of 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I and 1627K; optionally wherein said disease or    condition is a pain disease or condition.-   4. The ligand of any preceding clause, wherein said amino acid is    selected from the group consisting of 277X (wherein X is an amino    acid other than R), 328X (wherein X is an amino acid other than Y),    395K, 459X (wherein X is an amino acid other than S), 693 X (wherein    X is an amino acid other than E), 767X (wherein X is an amino acid    other than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K) and 1689X (wherein X is an amino acid other    than W); optionally wherein said disease or condition is a pain    disease or condition.-   5. The ligand of any preceding clause, wherein the VH gene segment    comprised by said human is a germline VH gene segment.-   6. The ligand of any preceding clause said method comprising, before    said administering, selecting a human comprising said nucleotide    sequence of (ii), wherein the human is the human of clause 1.-   7. The ligand of any preceding clause, wherein the human has been    determined to comprise the nucleotide sequence that encodes an    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G    and/or an Nav1.7 protein comprising said amino acid selected from    the group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,    863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K,    277X (wherein X is an amino acid other than R), 328X (wherein X is    an amino acid other than Y), 395K, 459X (wherein X is an amino acid    other than S), 693 X (wherein X is an amino acid other than E), 767X    (wherein X is an amino acid other than I), 830X (wherein X is an    amino acid other than R), 897X (wherein X is an amino acid other    than W), 1200L, 1235L, 1488X (wherein X is an amino acid other than    R), 1659X (wherein X is an amino acid other than K), 1689X (wherein    X is an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and    1919G.-   8. The ligand of any preceding clause, said method comprising the    step of determining that the human comprises (a) the nucleotide    sequence that encodes an Nav1.7 protein comprising said amino acid    selected from the group consisting of 136I, 216S, 241T, 395K, 848T,    858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,    1464I, 1627K, 277X (wherein X is an amino acid other than R), 328X    (wherein X is an amino acid other than Y), 395K, 459X (wherein X is    an amino acid other than S), 693 X (wherein X is an amino acid other    than E), 767X (wherein X is an amino acid other than I), 830X    (wherein X is an amino acid other than R), 897X (wherein X is an    amino acid other than W), 1200L, 1235L, 1488X (wherein X is an amino    acid other than R), 1659X (wherein X is an amino acid other than K),    1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,    1002L, 1161W and 1919G and/or (b) an Nav1.7 protein comprising said    mutation said amino acid selected from the group consisting of 136I,    216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D,    1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acid    other than R), 328X (wherein X is an amino acid other than Y), 395K,    459X (wherein X is an amino acid other than S), 693 X (wherein X is    an amino acid other than E), 767X (wherein X is an amino acid other    than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K), 1689X (wherein X is an amino acid other    than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, optionally,    wherein the determining step is performed before administration of    the antibody to the human.-   9. The ligand of clause 8, wherein the step of determining comprises    assaying a biological sample from the human for a nucleotide    sequence encoding a Nav1.7 protein comprising said amino acid    selected from the group consisting of 136I, 216S, 241T, 395K, 848T,    858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,    1464I, 1627K, 277X (wherein X is an amino acid other than R), 328X    (wherein X is an amino acid other than Y), 395K, 459X (wherein X is    an amino acid other than S), 693 X (wherein X is an amino acid other    than E), 767X (wherein X is an amino acid other than I), 830X    (wherein X is an amino acid other than R), 897X (wherein X is an    amino acid other than W), 1200L, 1235L, 1488X (wherein X is an amino    acid other than R), 1659X (wherein X is an amino acid other than K),    1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,    1002L, 1161W and 1919G.-   10. The ligand of clause 9, wherein the assaying comprises    -   contacting the biological sample with at least one        oligonucleotide probe comprising a sequence of at least 10        contiguous nucleotides of a nucleotide sequence encoding an        Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises a        nucleotide sequence encoding said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, thereby        forming a complex when at least one nucleotide sequence encoding        the Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G is        present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the Nav1.7 protein comprising said amino acid selected        from the group consisting of 136I, 216S, 241T, 395K, 848T, 858H,        858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,        1464I, 1627K, 277X (wherein X is an amino acid other than R),        328X (wherein X is an amino acid other than Y), 395K, 459X        (wherein X is an amino acid other than S), 693 X (wherein X is        an amino acid other than E), 767X (wherein X is an amino acid        other than I), 830X (wherein X is an amino acid other than R),        897X (wherein X is an amino acid other than W), 1200L, 1235L,        1488X (wherein X is an amino acid other than R), 1659X (wherein        X is an amino acid other than K), 1689X (wherein X is an amino        acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   11. The ligand of clause 9, wherein the assaying comprises nucleic    acid amplification and optionally one or more methods selected from    sequencing, next generation sequencing, nucleic acid hybridization,    and allele-specific amplification and/or wherein the assaying is    performed in a multiplex format.-   12. The ligand of clause 9 or 11, wherein said biological sample    comprises serum, blood, faeces, tissue, a cell, urine and/or saliva    of said human.-   13. The ligand of any preceding clause, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G,    optionally, wherein said human is further indicated as comprising    the nucleotide sequence of SEQ ID NO: 76, or said human is indicated    as homozygous for a nucleotide sequence encoding the Nav1.7 protein    comprising said amino acid selected from the group consisting of    136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,    1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an    amino acid other than R), 328X (wherein X is an amino acid other    than Y), 395K, 459X (wherein X is an amino acid other than S), 693 X    (wherein X is an amino acid other than E), 767X (wherein X is an    amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   14. The ligand of any preceding clause, wherein said human is or has    been further determined to be substantially resistant to a pain or    itching treatment.-   15. The ligand of any preceding clause, wherein said human is    receiving or has received a pain or itching treatment or has reduced    responsiveness to a pain or itching treatment.-   16. The ligand of any preceding clause, wherein said disease or    condition is a pain or itching disease or condition.-   17. The ligand of any preceding clause, wherein said disease or    condition is a channelopathy or associated with a channelopathy; or    is selected from the group consisting of primary erythermalgia (PE),    paroxysmal extreme pain disorder (PEPD) and channelopathy-associated    insensitivity to pain (CIP).-   18. The ligand of any preceding clause, wherein said human has been    diagnosed with at least one condition recited in claim 16 or 17.-   19. The ligand of any preceding clause, wherein said antibody or    antibody fragment treats or reduces the risk in said human of a    condition recited in claim 16 or 17.-   20. The ligand of any preceding clause, wherein the nucleotide    sequence comprises one or more SNPs selected from the group    consisting of rs6746030, rs3750904, rs58022607, rs4369876,    rs13402180 and rs12478318.-   21. The ligand of any preceding clause, wherein said ligand (eg,    antibody or antibody fragment) is for inhaled, intravenous or    subcutaneous administration and/or is comprised in an inhalable or    injectable preparation.-   22. The ligand of any preceding clause, wherein the human gamma-4    heavy chain constant region of the ligand comprises the amino acid    sequence of SEQ ID NO: 73 or an ADCC inactivated version thereof.-   23. The ligand of any preceding clause, wherein the human gamma-4    heavy chain constant region comprises 228P and 235E.

Methods with Gamma-2 Constant Region Tailoring

-   1. A method of treating or reducing the risk of a Nav1.7-mediated    disease or condition in a human in need thereof, the method    comprising administering to said human a ligand (eg, an antibody or    antibody fragment) that specifically binds a human Nav1.7 protein    that comprises an amino acid selected from the group consisting of    136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,    1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an    amino acid other than R), 328X (wherein X is an amino acid other    than Y), 395K, 459X (wherein X is an amino acid other than S), 693 X    (wherein X is an amino acid other than E), 767X (wherein X is an    amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G;    -   wherein (i) the ligand comprises a human gamma-2 heavy chain        constant region that comprises an amino acid selected from the        group consisting of a Pro at position 72 shown in SEQ ID NO: 6,        an Asn at position 75 shown in SEQ ID NO: 6, a Phe at position        76 shown in SEQ ID NO: 6, a Val at position 161 shown in SEQ ID        NO: 6 and an Ala at position 257 shown in SEQ ID NO: 6 and        wherein said human comprises (i) an IGHG2*01 human heavy chain        constant region gene segment, or the human expresses antibodies        comprising human gamma-2 heavy chain constant regions comprising        said selected Pro at position 72 shown in SEQ ID NO: 6, Asn at        position 75 shown in SEQ ID NO: 6, Phe at position 76 shown in        SEQ ID NO: 6, Val at position 161 shown in SEQ ID NO: 6 or Ala        at position 257 shown in SEQ ID NO: 6; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an alternative, clause 1 provides:—    -   A method of targeting Nav1.7 in a human, the method comprising        administering to said human a ligand (eg, an antibody or        antibody fragment) that specifically binds a human Nav1.7        protein that comprises an amino acid selected from the group        consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P,        1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K,        277X (wherein X is an amino acid other than R), 328X (wherein X        is an amino acid other than Y), 395K, 459X (wherein X is an        amino acid other than S), 693 X (wherein X is an amino acid        other than E), 767X (wherein X is an amino acid other than I),        830X (wherein X is an amino acid other than R), 897X (wherein X        is an amino acid other than W), 1200L, 1235L, 1488X (wherein X        is an amino acid other than R), 1659X (wherein X is an amino        acid other than K), 1689X (wherein X is an amino acid other than        W), 422D, 490N, 943L, 1002L, 1161W and 1919G;    -   wherein (i) the ligand comprises a human gamma-2 heavy chain        constant region that comprises an amino acid selected from the        group consisting of a Pro at position 72 shown in SEQ ID NO: 6,        an Asn at position 75 shown in SEQ ID NO: 6, a Phe at position        76 shown in SEQ ID NO: 6, a Val at position 161 shown in SEQ ID        NO: 6 and an Ala at position 257 shown in SEQ ID NO: 6 and        wherein said human comprises (i) an IGHG2*01 human heavy chain        constant region gene segment, or the human expresses antibodies        comprising human gamma-2 heavy chain constant regions comprising        said selected Pro at position 72 shown in SEQ ID NO: 6, Asn at        position 75 shown in SEQ ID NO: 6, Phe at position 76 shown in        SEQ ID NO: 6, Val at position 161 shown in SEQ ID NO: 6 or Ala        at position 257 shown in SEQ ID NO: 6; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an example, the human is suffering from or at risk of a        Nav1.7-mediated disease or condition.    -   In an example, the method treats or reduces the risk of a        Nav1.7-mediated disease or condition in the human.-   2. The method of any preceding clause, wherein said amino acid is    selected from the group consisting of any one of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P and 1449V; optionally wherein said    disease or condition is a pain disease or condition.-   3. The method of any preceding clause, wherein said amino acid is    selected from the group consisting of 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I and 1627K; optionally wherein said disease or    condition is a pain disease or condition.-   4. The method of any preceding clause, wherein said amino acid is    selected from the group consisting of 277X (wherein X is an amino    acid other than R), 328X (wherein X is an amino acid other than Y),    395K, 459X (wherein X is an amino acid other than S), 693 X (wherein    X is an amino acid other than E), 767X (wherein X is an amino acid    other than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K) and 1689X (wherein X is an amino acid other    than W); optionally wherein said disease or condition is a pain    disease or condition.-   5. The method of any preceding clause, wherein the constant region    gene segment comprised by said human is a germline gene segment.-   6. The method of any preceding clause comprising, before said    administering, selecting a human comprising said nucleotide sequence    of (ii), wherein the human is the human of clause 1.-   7. The method of any preceding clause, wherein the human has been    determined to comprise the nucleotide sequence that encodes an    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G    and/or an Nav1.7 protein comprising said amino acid selected from    the group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,    863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K,    277X (wherein X is an amino acid other than R), 328X (wherein X is    an amino acid other than Y), 395K, 459X (wherein X is an amino acid    other than S), 693 X (wherein X is an amino acid other than E), 767X    (wherein X is an amino acid other than I), 830X (wherein X is an    amino acid other than R), 897X (wherein X is an amino acid other    than W), 1200L, 1235L, 1488X (wherein X is an amino acid other than    R), 1659X (wherein X is an amino acid other than K), 1689X (wherein    X is an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and    1919G.-   8. The method of any preceding clause, comprising the step of    determining that the human comprises (a) the nucleotide sequence    that encodes an Nav1.7 protein comprising said amino acid selected    from the group consisting of 136I, 216S, 241T, 395K, 848T, 858H,    858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,    1627K, 277X (wherein X is an amino acid other than R), 328X (wherein    X is an amino acid other than Y), 395K, 459X (wherein X is an amino    acid other than S), 693 X (wherein X is an amino acid other than E),    767X (wherein X is an amino acid other than I), 830X (wherein X is    an amino acid other than R), 897X (wherein X is an amino acid other    than W), 1200L, 1235L, 1488X (wherein X is an amino acid other than    R), 1659X (wherein X is an amino acid other than K), 1689X (wherein    X is an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and    1919G and/or (b) an Nav1.7 protein comprising said mutation said    amino acid selected from the group consisting of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acid other    than R), 328X (wherein X is an amino acid other than Y), 395K, 459X    (wherein X is an amino acid other than S), 693 X (wherein X is an    amino acid other than E), 767X (wherein X is an amino acid other    than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K), 1689X (wherein X is an amino acid other    than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, optionally,    wherein the determining step is performed before administration of    the antibody to the human.-   9. The method of clause 8, wherein the step of determining comprises    assaying a biological sample from the human for a nucleotide    sequence encoding a Nav1.7 protein comprising said amino acid    selected from the group consisting of 136I, 216S, 241T, 395K, 848T,    858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,    1464I, 1627K, 277X (wherein X is an amino acid other than R), 328X    (wherein X is an amino acid other than Y), 395K, 459X (wherein X is    an amino acid other than S), 693 X (wherein X is an amino acid other    than E), 767X (wherein X is an amino acid other than I), 830X    (wherein X is an amino acid other than R), 897X (wherein X is an    amino acid other than W), 1200L, 1235L, 1488X (wherein X is an amino    acid other than R), 1659X (wherein X is an amino acid other than K),    1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,    1002L, 1161W and 1919G.-   10. The method of clause 9, wherein the assaying comprises    -   contacting the biological sample with at least one        oligonucleotide probe comprising a sequence of at least 10        contiguous nucleotides of a nucleotide sequence encoding an        Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises a        nucleotide sequence encoding said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, thereby        forming a complex when at least one nucleotide sequence encoding        the Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G is        present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the Nav1.7 protein comprising said amino acid selected        from the group consisting of 136I, 216S, 241T, 395K, 848T, 858H,        858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,        1464I, 1627K, 277X (wherein X is an amino acid other than R),        328X (wherein X is an amino acid other than Y), 395K, 459X        (wherein X is an amino acid other than S), 693 X (wherein X is        an amino acid other than E), 767X (wherein X is an amino acid        other than I), 830X (wherein X is an amino acid other than R),        897X (wherein X is an amino acid other than W), 1200L, 1235L,        1488X (wherein X is an amino acid other than R), 1659X (wherein        X is an amino acid other than K), 1689X (wherein X is an amino        acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   11. The method of clause 9, wherein the assaying comprises nucleic    acid amplification and optionally one or more methods selected from    sequencing, next generation sequencing, nucleic acid hybridization,    and allele-specific amplification and/or wherein the assaying is    performed in a multiplex format.-   12. The method of clause 9 or 11, wherein said biological sample    comprises serum, blood, faeces, tissue, a cell, urine and/or saliva    of said human.-   13. The method of any preceding clause, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G,    optionally, wherein said human is further indicated as comprising    the nucleotide sequence of SEQ ID NO: 76, or said human is indicated    as homozygous for a nucleotide sequence encoding the Nav1.7 protein    comprising said amino acid selected from the group consisting of    136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,    1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an    amino acid other than R), 328X (wherein X is an amino acid other    than Y), 395K, 459X (wherein X is an amino acid other than S), 693 X    (wherein X is an amino acid other than E), 767X (wherein X is an    amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   14. The method of any preceding clause, wherein said human is or has    been further determined to be substantially resistant to a pain or    itching treatment.-   15. The method of any preceding clause, wherein said human is    receiving or has received a pain or itching treatment or has reduced    responsiveness to a pain or itching treatment.-   16. The method of any preceding clause, wherein said disease or    condition is a pain or itching disease or condition.-   17. The method of any preceding clause, wherein said disease or    condition is a channelopathy or associated with a channelopathy; or    is selected from the group consisting of primary erythermalgia (PE),    paroxysmal extreme pain disorder (PEPD) and channelopathy-associated    insensitivity to pain (CIP).-   18. The method of any preceding clause, wherein said human has been    diagnosed with at least one condition recited in claim 16 or 17.-   19. The method of any preceding clause, wherein said antibody or    antibody fragment treats or reduces the risk in said human of a    condition recited in claim 16 or 17.-   20. The method of any preceding clause, wherein the nucleotide    sequence comprises one or more SNPs selected from the group    consisting of rs6746030, rs3750904, rs58022607, rs4369876,    rs13402180 and rs12478318.-   21. The method of any preceding clause, wherein said ligand (eg,    antibody or antibody fragment) is administered by inhaled,    intravenous or subcutaneous administration and/or is comprised in an    inhalable or injectable preparation.-   22. The method of any preceding clause, wherein the human gamma-2    heavy chain constant region of the ligand comprises IGHG2*01 amino    acid sequence or an ADCC inactivated version thereof.

Ligands with Gamma-2 Constant Region Tailoring

-   1. A ligand (eg, an antibody or antibody fragment) for use in a    method of treating or reducing the risk of a Nav1.7-mediated disease    or condition (eg, pain) in a human in need thereof, wherein the    ligand specifically binds a human Nav1.7 protein that comprises an    amino acid selected from the group consisting of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acid other    than R), 328X (wherein X is an amino acid other than Y), 395K, 459X    (wherein X is an amino acid other than S), 693 X (wherein X is an    amino acid other than E), 767X (wherein X is an amino acid other    than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K), 1689X (wherein X is an amino acid other    than W), 422D, 490N, 943L, 1002L, 1161W and 1919G;    -   wherein (i) the ligand comprises a human gamma-2 heavy chain        constant region that comprises an amino acid selected from the        group consisting of a Pro at position 72 shown in SEQ ID NO: 6,        an Asn at position 75 shown in SEQ ID NO: 6, a Phe at position        76 shown in SEQ ID NO: 6, a Val at position 161 shown in SEQ ID        NO: 6 and an Ala at position 257 shown in SEQ ID NO: 6 and        wherein said human comprises (i) an IGHG2*01 human heavy chain        constant region gene segment, or the human expresses antibodies        comprising human gamma-2 heavy chain constant regions comprising        said selected Pro at position 72 shown in SEQ ID NO: 6, Asn at        position 75 shown in SEQ ID NO: 6, Phe at position 76 shown in        SEQ ID NO: 6, Val at position 161 shown in SEQ ID NO: 6 or Ala        at position 257 shown in SEQ ID NO: 6; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an alternative, paragraph 1 provides:—    -   A ligand (eg, an antibody or antibody fragment) for use in a        method of targeting Nav1.7 in a human, wherein the ligand        specifically binds a human Nav1.7 protein that comprises an        amino acid selected from the group consisting of 136I, 216S,        241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D,        1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino        acid other than R), 328X (wherein X is an amino acid other than        Y), 395K, 459X (wherein X is an amino acid other than S), 693 X        (wherein X is an amino acid other than E), 767X (wherein X is an        amino acid other than I), 830X (wherein X is an amino acid other        than R), 897X (wherein X is an amino acid other than W), 1200L,        1235L, 1488X (wherein X is an amino acid other than R), 1659X        (wherein X is an amino acid other than K), 1689X (wherein X is        an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and        1919G;    -   wherein (i) the ligand comprises a human gamma-2 heavy chain        constant region that comprises an amino acid selected from the        group consisting of a Pro at position 72 shown in SEQ ID NO: 6,        an Asn at position 75 shown in SEQ ID NO: 6, a Phe at position        76 shown in SEQ ID NO: 6, a Val at position 161 shown in SEQ ID        NO: 6 and an Ala at position 257 shown in SEQ ID NO: 6 and        wherein said human comprises (i) an IGHG2*01 human heavy chain        constant region gene segment, or the human expresses antibodies        comprising human gamma-2 heavy chain constant regions comprising        said selected Pro at position 72 shown in SEQ ID NO: 6, Asn at        position 75 shown in SEQ ID NO: 6, Phe at position 76 shown in        SEQ ID NO: 6, Val at position 161 shown in SEQ ID NO: 6 or Ala        at position 257 shown in SEQ ID NO: 6; and    -   wherein (ii) said human comprises a nucleotide sequence encoding        said Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.    -   In an example, the human is suffering from or at risk of a        Nav1.7-mediated disease or condition.    -   In an example, the method treats or reduces the risk of a        Nav1.7-mediated disease or condition in the human.-   2. The ligand of any preceding clause, wherein said amino acid is    selected from the group consisting of any one of 136I, 216S, 241T,    395K, 848T, 858H, 858F, 863P and 1449V; optionally wherein said    disease or condition is a pain disease or condition.-   3. The ligand of any preceding clause, wherein said amino acid is    selected from the group consisting of 996C, 1298F, 1298D, 1299F,    1461T, 1462V, 1464I and 1627K; optionally wherein said disease or    condition is a pain disease or condition.-   4. The ligand of any preceding clause, wherein said amino acid is    selected from the group consisting of 277X (wherein X is an amino    acid other than R), 328X (wherein X is an amino acid other than Y),    395K, 459X (wherein X is an amino acid other than S), 693 X (wherein    X is an amino acid other than E), 767X (wherein X is an amino acid    other than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K) and 1689X (wherein X is an amino acid other    than W); optionally wherein said disease or condition is a pain    disease or condition.-   5. The ligand of any preceding clause, wherein the VH gene segment    comprised by said human is a germline VH gene segment.-   6. The ligand of any preceding clause said method comprising, before    said administering, selecting a human comprising said nucleotide    sequence of (ii), wherein the human is the human of clause 1.-   7. The ligand of any preceding clause, wherein the human has been    determined to comprise the nucleotide sequence that encodes an    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G    and/or an Nav1.7 protein comprising said amino acid selected from    the group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,    863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K,    277X (wherein X is an amino acid other than R), 328X (wherein X is    an amino acid other than Y), 395K, 459X (wherein X is an amino acid    other than S), 693 X (wherein X is an amino acid other than E), 767X    (wherein X is an amino acid other than I), 830X (wherein X is an    amino acid other than R), 897X (wherein X is an amino acid other    than W), 1200L, 1235L, 1488X (wherein X is an amino acid other than    R), 1659X (wherein X is an amino acid other than K), 1689X (wherein    X is an amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and    1919G.-   8. The ligand of any preceding clause, said method comprising the    step of determining that the human comprises (a) the nucleotide    sequence that encodes an Nav1.7 protein comprising said amino acid    selected from the group consisting of 136I, 216S, 241T, 395K, 848T,    858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,    1464I, 1627K, 277X (wherein X is an amino acid other than R), 328X    (wherein X is an amino acid other than Y), 395K, 459X (wherein X is    an amino acid other than S), 693 X (wherein X is an amino acid other    than E), 767X (wherein X is an amino acid other than I), 830X    (wherein X is an amino acid other than R), 897X (wherein X is an    amino acid other than W), 1200L, 1235L, 1488X (wherein X is an amino    acid other than R), 1659X (wherein X is an amino acid other than K),    1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,    1002L, 1161W and 1919G and/or (b) an Nav1.7 protein comprising said    mutation said amino acid selected from the group consisting of 136I,    216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F, 1298D,    1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an amino acid    other than R), 328X (wherein X is an amino acid other than Y), 395K,    459X (wherein X is an amino acid other than S), 693 X (wherein X is    an amino acid other than E), 767X (wherein X is an amino acid other    than I), 830X (wherein X is an amino acid other than R), 897X    (wherein X is an amino acid other than W), 1200L, 1235L, 1488X    (wherein X is an amino acid other than R), 1659X (wherein X is an    amino acid other than K), 1689X (wherein X is an amino acid other    than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, optionally,    wherein the determining step is performed before administration of    the antibody to the human.-   9. The ligand of clause 8, wherein the step of determining comprises    assaying a biological sample from the human for a nucleotide    sequence encoding a Nav1.7 protein comprising said amino acid    selected from the group consisting of 136I, 216S, 241T, 395K, 848T,    858H, 858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,    1464I, 1627K, 277X (wherein X is an amino acid other than R), 328X    (wherein X is an amino acid other than Y), 395K, 459X (wherein X is    an amino acid other than S), 693 X (wherein X is an amino acid other    than E), 767X (wherein X is an amino acid other than I), 830X    (wherein X is an amino acid other than R), 897X (wherein X is an    amino acid other than W), 1200L, 1235L, 1488X (wherein X is an amino    acid other than R), 1659X (wherein X is an amino acid other than K),    1689X (wherein X is an amino acid other than W), 422D, 490N, 943L,    1002L, 1161W and 1919G.-   10. The ligand of clause 9, wherein the assaying comprises    -   contacting the biological sample with at least one        oligonucleotide probe comprising a sequence of at least 10        contiguous nucleotides of a nucleotide sequence encoding an        Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G or        comprising an antisense sequence of said contiguous nucleotides,        wherein said sequence of contiguous nucleotides comprises a        nucleotide sequence encoding said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G, thereby        forming a complex when at least one nucleotide sequence encoding        the Nav1.7 protein comprising said amino acid selected from the        group consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F,        863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I,        1627K, 277X (wherein X is an amino acid other than R), 328X        (wherein X is an amino acid other than Y), 395K, 459X (wherein X        is an amino acid other than S), 693 X (wherein X is an amino        acid other than E), 767X (wherein X is an amino acid other than        I), 830X (wherein X is an amino acid other than R), 897X        (wherein X is an amino acid other than W), 1200L, 1235L, 1488X        (wherein X is an amino acid other than R), 1659X (wherein X is        an amino acid other than K), 1689X (wherein X is an amino acid        other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G is        present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises the Nav1.7 protein comprising said amino acid selected        from the group consisting of 136I, 216S, 241T, 395K, 848T, 858H,        858F, 863P, 1449V, 996C, 1298F, 1298D, 1299F, 1461T, 1462V,        1464I, 1627K, 277X (wherein X is an amino acid other than R),        328X (wherein X is an amino acid other than Y), 395K, 459X        (wherein X is an amino acid other than S), 693 X (wherein X is        an amino acid other than E), 767X (wherein X is an amino acid        other than I), 830X (wherein X is an amino acid other than R),        897X (wherein X is an amino acid other than W), 1200L, 1235L,        1488X (wherein X is an amino acid other than R), 1659X (wherein        X is an amino acid other than K), 1689X (wherein X is an amino        acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   11. The ligand of clause 9, wherein the assaying comprises nucleic    acid amplification and optionally one or more methods selected from    sequencing, next generation sequencing, nucleic acid hybridization,    and allele-specific amplification and/or wherein the assaying is    performed in a multiplex format.-   12. The ligand of clause 9 or 11, wherein said biological sample    comprises serum, blood, faeces, tissue, a cell, urine and/or saliva    of said human.-   13. The ligand of any preceding clause, wherein said human is    indicated as heterozygous for a nucleotide sequence encoding the    Nav1.7 protein comprising said amino acid selected from the group    consisting of 136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V,    996C, 1298F, 1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein    X is an amino acid other than R), 328X (wherein X is an amino acid    other than Y), 395K, 459X (wherein X is an amino acid other than S),    693 X (wherein X is an amino acid other than E), 767X (wherein X is    an amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G,    optionally, wherein said human is further indicated as comprising    the nucleotide sequence of SEQ ID NO: 76, or said human is indicated    as homozygous for a nucleotide sequence encoding the Nav1.7 protein    comprising said amino acid selected from the group consisting of    136I, 216S, 241T, 395K, 848T, 858H, 858F, 863P, 1449V, 996C, 1298F,    1298D, 1299F, 1461T, 1462V, 1464I, 1627K, 277X (wherein X is an    amino acid other than R), 328X (wherein X is an amino acid other    than Y), 395K, 459X (wherein X is an amino acid other than S), 693 X    (wherein X is an amino acid other than E), 767X (wherein X is an    amino acid other than I), 830X (wherein X is an amino acid other    than R), 897X (wherein X is an amino acid other than W), 1200L,    1235L, 1488X (wherein X is an amino acid other than R), 1659X    (wherein X is an amino acid other than K), 1689X (wherein X is an    amino acid other than W), 422D, 490N, 943L, 1002L, 1161W and 1919G.-   14. The ligand of any preceding clause, wherein said human is or has    been further determined to be substantially resistant to a pain or    itching treatment.-   15. The ligand of any preceding clause, wherein said human is    receiving or has received a pain or itching treatment or has reduced    responsiveness to a pain or itching treatment.-   16. The ligand of any preceding clause, wherein said disease or    condition is a pain or itching disease or condition.-   17. The ligand of any preceding clause, wherein said disease or    condition is a channelopathy or associated with a channelopathy; or    is selected from the group consisting of primary erythermalgia (PE),    paroxysmal extreme pain disorder (PEPD) and channelopathy-associated    insensitivity to pain (CIP).-   18. The ligand of any preceding clause, wherein said human has been    diagnosed with at least one condition recited in claim 16 or 17.-   19. The ligand of any preceding clause, wherein said antibody or    antibody fragment treats or reduces the risk in said human of a    condition recited in claim 16 or 17.-   20. The ligand of any preceding clause, wherein the nucleotide    sequence comprises one or more SNPs selected from the group    consisting of rs6746030, rs3750904, rs58022607, rs4369876,    rs13402180 and rs12478318.-   21. The ligand of any preceding clause, wherein said ligand (eg,    antibody or antibody fragment) is for inhaled, intravenous or    subcutaneous administration and/or is comprised in an inhalable or    injectable preparation.-   22. The ligand of any preceding clause, wherein the human gamma-2    heavy chain constant region of the ligand comprises IGHG2*01 amino    acid sequence or an ADCC inactivated version thereof.

1000 GENOMES PROJECT HUMAN POPULATIONS Below is a summary of the ethnicpopulations as per the 1000 Genomes Project sequences. PopulationEuropean ancestry Utah residents (CEPH) with Northern and WesternEuropean ancestry (CEU) Toscani in Italia (TSI) British from England andScotland (GBR) Finnish from Finland (FIN) Iberian populations in Spain(IBS) East Asian ancestry Han Chinese in Beijing, China (CHB) Japanesein Toyko, Japan (JPT) Han Chinese South (CHS) Chinese Dai inXishuangbanna (CDX) Kinh in Ho Chi Minh City, Vietnam (KHV) Chinese inDenver, Colorado (CHD) (pilot 3 only) West African ancestry Yoruba inIbadan, Nigeria (YRI) Luhya in Webuye, Kenya (LWK) Gambian in WesternDivision, The Gambia (GWD) Malawian in Blantyre, Malawi (MAB) WestAfrican Population (TBD) Americas African Ancestry in Southwest US (ASW)African American in Jackson, MS (AJM) African Caribbean in Barbados(ACB) Mexican Ancestry in Los Angeles, CA (MXL) Puerto Rican in PuertoRico (PUR) Colombian in Medellin, Colombia (CLM) Peruvian in Lima, Peru(PEL) South Asian ancestry Ahom in the State of Assam, India Kayadtha inCalcutta, India Reddy in Hyderabad, India Maratha in Bombay, IndiaPunjabi in Lahore, Pakistan

TABLE 5 TOIs & Related Diseases, Conditions and Example Ligands ExampleDisease or Human TOI Condition Example Ligand I1-17a InflammatoryDisease AIN457 Uveitis Ixekizumab Rheumatoid Arthritis PsoriasisAngiotensin II Receptor Hypertension LCZ696 Type 1 (AT₁) NeprilysinHypertension LCZ696 Metabotropic Glutamate Fragile X Syndrome AFQ056Receptor 5 (Mglur5) Mavoglurant A Histone Deacetylase Cancer, Eg,Multiple LBH589 Myeloma Panobinostat Diacylglycerol Familial LCQ908acyltransferase-1 (DGAT-1) Chylomicronaemia Pradigastat SyndromeSmoothened (Smo) Basal cell carcinoma LDE225 Solid tumour MyelofibrosisMedulloblastoma Solid tumour Smoothened (Smo) receptor Basal cellcarcinoma LEQ506 Solid tumors ALK Non small cell lung LDK378 carcinoma(NSCLC) phosphatidylinositol- Cancer, eg, solid tumour, BKM120 3-kinase(PI3K) breast cancer, Renal cell mTOR carcinoma (RCC), AKT Endometrialcancer, Non- small cell lung cancer (NSCLC), prostate cancer,Glioblastoma multiforme (GBM) CRPC GIST Myelofibrosis mTOR Cancer, eg,solid tumour, BEZ235 PI3K breast cancer, Renal cell AKT carcinoma (RCC),Endometrial cancer, Non- small cell lung cancer (NSCLC), prostatecancer, Glioblastoma multiforme (GBM) CRPC GIST Myelofibrosis PI3KαCancer, eg, solid tumour, BYL719 mTOR breast cancer, Renal cell PI3Kcarcinoma (RCC), AKT Endometrial cancer, Non- small cell lung cancer(NSCLC), prostate cancer, Glioblastoma multiforme (GBM) CRPC GISTMyelofibrosis Mitogen-activated Cancer, eg, solid tumour, MEK162 ERKkinase 1 (MEK1) melanoma, pancreatic, Mitogen-activated colon, lung orthyroid ERK kinase 2 (MEK2) cancer Metastasis protein kinase Acutemyeloid leukemia PKC412 protein kinase C (AML) Midostaurin FLT-3Myelodysplastic syndrome c-KIT (MDS) Aggressive systemic mastocytosis(ASM) ActRIIB Sporadic inclusion body BYM338 myositis (sIBM) bimagrumabCD19 Cancer, eg, CTL019 (formerly Leukaemia, mast CART-19) cellleukemia, Acute Lymphoblastic Leukemia, Chronic lymphocytic leukemia(CLL) or Hematological tumors 11β-hydroxylase Cushing's syndrome LCI699BRAF Cancer, eg, melanoma LGX818 Receptor Tyrosine Kinase Cancer, eg,solid TKI258 (formerly FGFR tumour CHIR-258) Breast Cancer DovitinibEndometrial cancer Hepatocellular carcinoma Renal cell carcinoma (RCC)Bladder cancer multiple myeloma (MM), hepatocellular carcinomaendometrial cancer DAC enzyme hematologic malignancy LBH589 Multiplemyeloma panobinostat Myel\odysplastic syndrome (MDS) Myelofibrosis HSP90Cancer, eg, Breast AUY922 Cancer, gastric cancer or Non- small cell lungcancer (NSCLC) FGFR Cancer, eg, solid BGJ398 tumour Breast CancerEndometrial cancer Hepatocellular carcinoma Renal cell carcinoma (RCC)Bladder cancer multiple myeloma (MM), hepatocellular carcinomaendometrial cancer cIAP1 Cancer, eg, solid LCL161 cIAP2 tumour BreastCancer Endometrial cancer Hepatocellular carcinoma Renal cell carcinoma(RCC) Bladder cancer multiple myeloma (MM), hepatocellular carcinomaendometrial cancer Akt Cancer, eg, Solid GDC-0068 tumour, gastric RG7440cancer (eg, castration-resistant prostate cancer), prostate cancer,gastroesophageal junction cancer CD22 Hematologic malignancies DCDT2980SNon-Hodgkin's lymphoma RG7593 (eg, relapsed or refractory follicularnon-Hodgkin's lymphoma) Diffuse large B-cell lymphoma (eg, relapsed orrefractory diffuse large B- cell lymphoma) CD79b Hematologicmalignancies DCDS4501A Non-Hodgkin's lymphoma RG7596 (eg, relapsed orrefractory follicular non-Hodgkin's lymphoma) Diffuse large B-celllymphoma (eg, relapsed or refractory diffuse large B- cell lymphoma)endothelin B receptor (ETBR) Melanoma, eg, metastatic DEDN6526A orunresectable melanoma RG7636 HER3 Cancer, eg, metastatic MEHD7945Aepithelial tumour, RG7597 metastatic squamous cell carcinoma of the headand neck cancer, metastatic colorectal cancer EGFR Cancer, eg,metastatic MEHD7945A epithelial tumour, RG7597 metastatic squamous cellNecitumumab carcinoma of the head and neck cancer, metastatic colorectalcancer MUC16 Cancer, eg, ovarian cancer DMUC5754A (eg,platinum-resistant RG7458 ovarian cancer) sodium-dependent phosphateCancer, eg, metastatic non- DNIB0600A transport protein 2b (NaPi2b)squamous non-small cell RG7599 lung cancer, ovarian cancer (eg,platinum-resistant ovarian cancer) PDL1 (programmed Cancer, eg, solidtumour MPDL3280A death ligand 1) metastatic melanoma RG7446 non-smallcell lung cancer STEAP1 (six-transmembrane Cancer, eg, prostate cancerDSTP3086S epithelial antigen (eg, metastatic castration- RG7450 of theprostate 1) resistant prostate cancer) Bc1-2 Cancer, eg, leukaemia (eg,GDC-0199 chronic lymphocytic RG7601 leukaemia), non-Hodgkin's lymphomaCheckpoint kinase 1 (ChK1) Cancer, eg, solid tumour, GDC-0425 refractorysolid tumour or RG7602 lymphoma GDC-0575 RG7741 mitogen activatedprotein Cancer, eg, solid tumour, GDC-0973 kinase kinase (MAPKK)melanoma (eg, metastatic RG7421 MEK melanoma) Cobimetinib GDC-0623RG7420 epidermal growth factor Cancer, eg, colorectal Parsatuzumabdomain-like-7 (EGFL7) cancer (eg, metastatic MEGF0444A colorectalcancer), NSCLC RG7414 phosphatidylinositol- Cancer, eg, prostate cancer,GDC-0032 3-kinase (PI3K) renal cell carcinoma, RG7604 endometrialcancer, breast GDC-0084 cancer (eg, HER2-negative RG7666 metastaticbreast cancer, Pictilisib metastatic hormone GDC-0941 receptor-positivebreast RG7321 cancer), solid tumour mTOR Cancer, eg, prostate cancer,GDC-0980 TORC1 renal cell carcinoma, RG7422 TORC2 endometrial cancer,breast PI3K cancer (eg, HER2-negative metastatic breast cancer,metastatic hormone receptor-positive breast cancer), solid tumour IL17Autoimmune disease Secukinumab Ankylosing spondylitis; ixekizumabAsthma; Multiple myeloma; Multiple sclerosis; Polymyalgia rheumatica;Psoriasis; Psoriatic arthritis; Rheumatoid arthritis; Uveitis M1 primesegment of Allergic Asthma Quilizumab membrane IgE MEMP1972A RG7449 IFNalpha Autoimmune disease Rontalizumab Systemic lupus erythematosus PCSK9(proprotein convertase coronary heart disease MPSK3169A subtilisin/kexintype 9) (CHD) or high risk of CHD RG7652 hyperlipidaemiahypercholesterolaemia stroke atherosclerosis a cardiovascular disease orcondition a condition associated with elevated LDL Vascular EndothelialGrowth Diabetic Macular Edema EYLEA ® Factor-A (VEGF-A) (DME),Aflibercept Placental Growth Branch Retinal Vein AVASTIN ™ Factor (PlGF)Occlusion (BRVO) LUCENTIS ™ Wet age-related macular degeneration (WetAMD) IL-6 receptor Inflammatory disease, eg, Sarilumab rheumatoidarthritis REGN88 Uveitis (eg, non-infectious uveitis) Ankylosingspondylitis; Cancer PCSK9 (proprotein convertase coronary heart diseaseAlirocumab subtilisin/kexin type 9) (CHD) or high risk of CHD REGN727hyperlipidaemia LY3015014 hypercholesterolaemia stroke atherosclerosis acardiovascular disease or condition a condition associated with elevatedLDL NGF Osteoarthritis Fasinumab Pain REGN475 IL-4 receptor alphaAllergic asthma Dupilumab IL-13 receptor eosinophilic asthma REGN668Atopic dermatitis delta-like ligand-4 (DII4) Cancer Enoticumab REGN421angiopoietin-2 (Ang2) Cancer Nesvacumab REGN910 GDF8 Metabolic disorderREGN1033 cancer, obesity, diabetes, LY2495655 arthritis, multiplesclerosis, muscular dystrophy, amyotrophic lateral sclerosis,Parkinson's disease, osteoporosis, osteoarthritis, osteopenia, metabolicsyndromes (including, but not limited to diabetes, obesity, nutritionaldisorders, organ atrophy, chronic obstructive pulmonary disease andanorexia) Disuse muscle atrophy cancer-related cachexia ERBB3 CancerREGN1400 angiopoietin -1 (Ang1) Cancer, eg, ovarian cancer AMG386angiopoietin -1 (Ang2) VEGF receptor Cancer Motesanib PDGF receptorNSCLC AMG 706 Stem cell factor receptor Breast cancer Thyroid cancertype 1 insulin-like growth Cancer Ganitumab factor receptor (IGF1R)Breast cancer Linsitinib Pancreatic cancer ASP7487 hepatocyte growthCancer Rilotumumab factor (HGF) Breast cancer Pancreatic cancer HER3Cancer AMG 888 ErbB3 Breast cancer U3-1287 Pancreatic cancer IL-17receptor Inflammatory disease AMG 827 Asthma brodalumab Psoriasissclerostin Bone-related condition AMG 785 postmenopausal CDP7851osteoporosis fracture healing glucokinase Diabetes AMG 151 ARRY-403PCSK9 (proprotein convertase coronary heart disease AMG 145subtilisin/kexin type 9) (CHD) or high risk of CHD Evolocumabhyperlipidaemia hypercholesterolaemia stroke atherosclerosis acardiovascular disease or condition a condition associated with elevatedLDL VLA 2 Inflammatory bowel SAR339658 Integrin α2β1 disease IL-4Idiopathic pulmonary SAR156597 IL-13 fibrosis lysophosphatidic acidreceptor Systemic sclerosis SAR100842 LPA-1 fibrosis LPA-3 Androgenreceptor Cancer, eg, prostate cancer, MDV3100 breast cancer enzalutamideHER1 Cancer, eg, NSCLC Erlotinib EGFR ERBITUX ™ VECTIBIX ™ VEGF receptor1 Cancer, eg, colorectal ASP4130 VEGF receptor 2 cancer, breast cancertivozanib VEGF receptor 3 JAK Inflammatory disease, eg, ASP015K JAK1rheumatoid arthritis Baricitinib JAK2 Diabetic nephropathy CD40Prevention of organ ASP1240 transplant rejection GnRH EndometriosisASP1707 Cancer, eg, prostate cancer degarelix PDE9 Lower unirary tractASP4901 symptoms associated with benign prostatic hyperplasia TNF alphaInflammatory disease, eg, Certolizumab rheumatoid arthritis, pegolpsoriasis, chrohn's disease, IBD Programmed cell death Cancer Nivolumabprotein 1 Chronic myelocytic MK-3475 leukemia; Hepatitis C virusinfection; Hepatocellular carcinoma; Hodgkins disease; Melanoma;Multiple myeloma; Non- Hodgkin lymphoma; Non- small-cell lung cancer;Renal cell carcinoma; Solid tumor; Stage IV melanoma Hepatocyte growthfactor Cancer onartuzumab MET Glioblastoma; Hepatocellular carcinoma;Metastatic colorectal cancer; Metastatic non small cell lung cancer;Metastatic stomach cancer; Non-small-cell lung cancer Angiopoietinligand-1 Breast tumor; Cancer; trebananib Angiopoietin ligand-2Colorectal tumor; Fallopian Tek tyrosine kinase receptor tube cancer;Gastrointestinal tumor; Glioblastoma; Hepatocellular carcinoma;Metastatic esophageal cancer; Metastatic gastrointestinal cancer;Metastatic non small cell lung cancer; Metastatic ovary cancer;Metastatic renal cancer; Ovary tumor; Peritoneal tumor; Transitionalcell carcinoma CD37 modulator Cancer elotuzumab Lymphocyte functionMultiple myeloma antigen-3 receptor SLAM family member 7 IL-2 Multiplesclerosis daclizumab IL-2 receptor alpha EGFR Cancer necitumumabMetastatic non small cell lung cancer; Solid tumor IL-5 Asthma;Eosinophilic reslizumab esophagitis B-lymphocyte cell adhesion Cancer,eg Acute Inotuzumab molecule CD22 lymphoblastic leukemia; inotuzumabFollicle center lymphoma; ozogamicin Non-Hodgkin lymphoma; epratuzumabSystemic lupus moxetumomab erythematosus, moxetumomab hairy cellleukaemia pasudotox IL1 beta Acne vulgaris; gevokizumab Atherosclerosis;Behcets disease; Cardiovascular disease; Dermatomyositis; Insulindependent diabetes; Multiple myeloma; Osteoarthritis; Paraproteinemia;Polymyositis; Pyoderma gangrenosum; Scleritis; Uveitis CD20 CancerOcrelizumab Multiple sclerosis ofatumumab follicular lymphoma (eg,refractory or relapsed) diffuse large B cell lymphoma (eg, relapsed)chronic lymphocytic leukaemia (eg, first line therapy or relapsed) IL-23Crohns disease; tildrakizumab Inflammatory disease; Psoriasis BAFFAutoimmune disease Belimumab Neutrokine alpha systemic lupus Benlysta ™erythematosus Tabalumab Multiple myeloma vasculitis IL5 Asthmamepolizumab IL6 Inflammatory disease sirukumab rheumatoid arthritisLp-PLA2 Atherosclerosis darapladib diabetic macular oedema CCR9chemokine receptor Inflammatory disease Vercirnon rheumatoid arthritisCrohn's disease DOPA decarboxylase Parkinson's Disease Patrome Her2Cancer, eg, gastric cancer, Tyverb ™ EGFR breast cancer, head andTykerb ™ neck squamous cell cancer, lapatinib ADP receptorCardiovascular disease or Brilinta condition Brilique Thrombosis, eg,arterial thrombosis VEGFR Cancer, eg, Caprelsa EGFR medullary thyroidcancer LABA Respiratory disease or PT003 GFF LAMA condition,eg, COPDFactor Xa thromboembolism apixaban OX40 ligand Asthma OxelumabGraft-versus-host disease CTLA-4 Cancer, eg, melanoma Tremelimumab CD152Autoimmune disease Ticilimumab ipilimumab PD-L1 Cancer, eg, solidtumour, MPDL3280A kidney cancer, lung cancer, MEDI4736 melanoma, NSCLC,multiple myeloma Autoimmune disease PD-1 Cancer, eg, solid tumour,Nivolumab kidney cancer, lung cancer, Keytruda melanoma, NSCLC, AMP-514multiple myeloma AMP-224 Autoimmune disease LIGHT TNFSF14 CD40 ligandJAK Inflammatory disease, eg, tofacitinib rheumatoid arthritis,psoriasis, chrohn's disease, IBD, ulcerative colitis, PsoriaticArthritis Nerve Growth Factor Pain tanezumab Osteoarthritis pain Her1receptor Cancer, eg, Non-Small Cell dacomitinib Her2 receptor LungCancer Her4 receptor c-MET Cancer, eg, Non-Small Cell crizotinib ALKLung Cancer Programmed cell death Cancer, eg, renal cell Nivolumab 1receptor carcinoma SLAMF7 Cancer, eg, multiple Elotuzumab CD319 myelomaCD30 Cancer, eg, Hodgkin Brentuximab lymphoma, systemic Brentuximabanaplastic large cell vedotin lymphoma, T-cell lymphoma GPR40 Diabetes,eg, diabetes Fasiglifam DPP-4 mellitus trelagliptin VEFGR-1 receptorCancer, eg, non-squamous Motesanib VEFGR-2 receptor non-small cell lungcancer Motesanib VEFGR-3 receptor diphosphate PDGFR cKit amyloid βAlzheimer's disease Solanezumab TNF alpha Inflammatory disease, eg,SIMPONI ™ rheumatoid arthritis, HUMIRA ™ psoriasis, chrohn's disease,REMICADE ™ IBD, ulcerative colitis, ENBREL ™ Psoriatic ArthritisAdalimumab IL-21 Autoimmune disease or Agonist or antagonist conditionantibody specific for Inflammatory disease or human IL-21 conditionNNC0114-0005 Rheumatoid arthritis NNC0114-0006 Crohn's disease NN8828IBD ATR-107 Ulcerative colitis Said or an anti-IL-21 Systemic lupusantibody in combination erythematosus (SLE) with an agent selected fromGraft versus host disease the group consisting of Cancer ipilimumab (eg,to treat Metastatic melanoma melanoma), an anti-PD1 Renal cell carcinomaantibody (eg, to treat solid Melanoma tumours), sunitinib (eg, to Solidtumours treat renal cell carcinoma), Acute myeloid leukaemia rituximab(eg, to treat Non- Non-Hodgkin's lymphoma Hodgkin's lymphoma), Ovariancancer sorafenib (eg, to treat renal Colorectal cancer cell carcinoma),doxorubicin (eg, to treat ovarian cancer) and cetuximab (eg, to treatcolorectal cancer). TIGIT immuno-oncology condition DMAM-1(immuno-oncology) CD96 (immuno-oncology) DR3 (agonist forimmuno-oncology) TL1A, DR3 (blocker for inflammatory disease) DMAM-1immuno-oncology condition CD96 immuno-oncology condition DR3immuno-oncology condition Agonist inflammatory disease Antagonist TL1Ainflammatory disease TIM3 CD200 CSF1R LAG3 GITR CD40

TABLE 6 PCSK9 SEQUENCES SEQ FORM/ ID ALLELE VERSION SEQUENCE NO: AMINOACID SEQUENCES Italics = signal sequence 1-30

lower case = catalytic domain 153-449 UPPER CASE = C-terminal domain450-692 Underlined = residues changed from allelle a in other sequences(aa residue number shown) a Pro-Form with

 1 Signal

Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

a Pro-Form

 2

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

a Maturesipwnleritppryradayqppdggslvevylldtsiqsdhreiegrvmvtdfenvpeedgtrfhrqaskcdshg 3 formthlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqltvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

f Pro-Form with

 4 Signal

Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

f Pro-Form

 5

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

f, p, aj Maturesipwnleritppryradayqppdggslvevylldtsiqsdhreiegrvmvtdfenvpeedgtrfhrqaskcdshg 6 formthlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqltvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

c Pro-Form with

 7 Signal

Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

c Pro-Form

 8

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

c, q Maturesipwnleritppryradayqppdggslvevylldtsiqsdhreiegrvmvtdfenvpeedgtrfhrqaskcdshg 9 formthlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqltvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

r Pro-Form with

10 Signal

Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

r Pro-Form

11

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

r Maturesipwnleritppryradayqppdggslvevylldtsiqsdhreiegrvmvtdfenvpeedgtrfhrqaskcdshg12 formthlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqltvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

p Pro-Form with

13 Signal

Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

p Pro-Form

14

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

m Pro-Form with

15 Signal

Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

m Pro-Form

16

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

m Maturesipwnleritppryradayqppdggslvevylldtsiqsdhreiegrvmvtdfenvpeedgtrfhrqaskcdshg17 formthlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqltvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

e Pro-Form with

18 Signal

Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

e Pro-Form

19

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

e Maturesipwnleritppryradayqppdggslvevylldtsiqsdhreiegrvmvtdfenvpeedgtrfhrqaskcdshg20 formthlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqltvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

h Pro-Form with

21 Signal

Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

h Pro-Form

22

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

h Maturesipwnleritppryradayqppdggslvevylldtsiqsdhreiegrvmvtdfenvpeedgtrfhrqaskcdshg23 formthlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqltvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

aj Pro-Form with

24 Signal

Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

aj Pro-Form

25

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

q Pro-Form with

26 Signal

Sequence

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

q Pro-Form

27

thlagvvsgrdagvakgasmrslrvlncqgkgtvsgtliglefirksqlvqpvgplvvllplaggysrvlnaacqrlaragvvlvtaagnfrddaclyspasapevitvgatnaqdqpvtlgtlgtnfgrcvdlfapgediigassdcstcfvsqsgtsqaaahvagiaammlsaepeltlaelrqrlihfsak

EAQGGKLVCRAHNAFGGEGVYAIARCCLLPQANCSVHTAPPAEASMGTRVHCHQQGHVLTGCSSHWEVEDLGT

NUCLEOTIDE SEQUENCES Italics = nucleotide sequence encoding signalsequence (nucleotide 1-90)

lower case = nucleotide sequence encoding catalytic domain (nucleotides457-1346) UPPER CASE = nucleotide sequence encoding C-terminal domain(nucleotides 1347-2076) aATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC28

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

CCTCCCAGGAGCTCCAGTGAC fATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC29

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

CCTCCCAGGAGCTCCAGTGAC cATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC30

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

CCTCCCAGGAGCTCCAGTGAC rATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC31

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

CCTCCCAGGAGCTCCAGTGAC pATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC32

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

CCTCCCAGGAGCTCCAGTGAC mATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC33

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

CCTCCCAGGAGCTCCAGTGAC eATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC34

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

CCTCCCAGGAGCTCCAGTGAC hATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC35

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

CCTCCCAGGAGCTCCAGTGAC ajATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC36

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

CCTCCCAGGAGCTCCAGTGAC qATGGGCACCGTCAGCTCCAGGCGGTCCTGGTGGCCGCTGCCACTGCTGCTGCTGCTGCTGCTGCTCCTGGGTC37

cggtaccgggcggatgaataccagccccccgacggaggcagcctggtggaggtgtatctcctagacaccagcatacagagtgaccaccgggaaatcgagggcagggtcatggtcaccgacttcgagaatgtgcccgaggaggacgggacccgcttccacagacaggccagcaagtgtgacagtcatggcacccacctggcaggggtggtcagcggccgggatgccggcgtggccaagggtgccagcatgcgcagcctgcgcgtgctcaactgccaagggaagggcacggttagcggcaccctcataggcctggagtttattcggaaaagccagctggtccagcctgtggggccactggtggtgctgctgcccctggcgggtgggtacagccgcgtcctcaacgccgcctgccagcgcctggcgagggctggggtcgtgctggtcaccgctgccggcaacttccgggacgatgcctgcctctactccccagcctcagctcccgaggtcatcacagttggggccaccaatgcccaagaccagccggtgaccctggggactttggggaccaactttggccgctgtgtggacctctttgccccaggggaggacatcattggtgcctccagcgactgcagcacctgctttgtgtcacagagtgggacatcacaggctgctgcccacgtggctggcattgcagccatgatgctgtctgccgagccggagctcaccctggccgagttgaggcagagactg

cacccatGGGGCAGGTTGGCAGCTGTTTTGCAGGACTGTATGGTCAGCACACTCGGGGCCTACACGGATGGCC

CGGGGCGAGCGCATGGAGGCCCAAGGGGGCAAGCTGGTCTGCCGGGCCCACAACGCTTTTGGGGGTGAGGGTGTCTACGCCATTGCCAGGTGCTGCCTGCTACCCCAGGCCAACTGCAGCGTCCACACAGCTCCACCAGCTGAGGCCAGCATGGGGACCCGTGTCCACTGCCACCAACAGGGCCACGTCCTCACAGGCTGCAGCTCCCACTGGGAGGTGGAGGACCTTGGCACCCACAAGCCGCCTGTGCTGAGGCCACGAGGTCAGCCCAACCAGTGCGTGGGCCACAGGGAGGCCAGCATCCACGCTTCCTGCTGCCATGCCCCAGGTCTGGAATGCAAAGTCAAGGAGCATGGAA

CTGGGACCTCCCACGTCCTGGGGGCCTACGCCGTAGACAACACGTGTGTAGTCAGGAGCCGGGACGTCAGCA

CCTCCCAGGAGCTCCAGTGAC

TABLE 7 Human VH3-23 Variant Alleles VH3-23 Cumulative allele haplotypefrequency SNPs a (=VH3 − 23 * 04) 0.0983 rs56069819 d 0.0087 rs56069819rs61750837 rs61752504 e 0.0046 rs56069819 rs1064090 rs1055799 j 0.0009rs56069819 rs1055799 u 0.0005 rs56069819 rs1064091 s 0.0005 rs56069819rs1064091 rs61752504 rs61750837 r 0.0005 rs56069819 rs1064090 TOTAL:0.114

TABLE 8 Exemplary anti-PCSK9 antibodies and/or antibody fragments SEQ IDNOs comprising an anti-PCSK9 patent or monoclonal antibody or fragmentthereof patent Publication Light chain complementary determining regionsUS20120020975A1 (CDRL) SEQ ID NO: 5, 7, 9, 10, 12, 13, 14, 15, 16, 17,18, 19, 20, 21, 22, 23, 24, 26, 28, 30, 31, 32, 33, 35, 36, 37, 38, 39,40, 42, 44, 46, 270, 271, 272, 273, 275, 277, 286, 287, 288, 297, 299,301, 405, 407, 409, 411, 413, 415, 417, 421, 425, 429, 433, 437, 441,445, 449, 453, 457, 461, 465, 469, 473, 477, 481, 485; Heavy chaincomplementary determining regions (CDRH) SEQ ID NO: 47, 48, 49, 50, 51,52, 53, 54, 55, 56, 57, 58, 60, 61, 62, 64, 65, 67, 69, 71, 72, 74, 76,77, 78, 79, 80, 81, 83, 85, 87, 89, 91, 278, 289, 290, 291, 292, 298,300, 302, 401, 404, 406, 408, 410, 412, 414, 416, 419, 423, 427, 431,435, 439, 443, 447, 451, 455, 459, 463, 467, 471, 475, 479, 483; CDRLSEQ ID NO: 5, 7, 9, 10, 12, 13, 15, 16, US20120027765A1 17, 18, 19, 20,21, 22, 23, 24, 26, 28, 30, 31, 32, 33, 35, 36, 37, 38, 39, 40, 42, 44,46, 405, 407, 409, 411, 413, 415, 417, 465; CDRH SEQ ID NO: 47, 48, 49,50, 51, 52, 53, 54, 55, 56, 57, 58, 60, 62, 64, 65, 67, 69, 71, 72, 74,76, 77, 78, 79, 80, 81, 83, 85, 87, 89, 91, 404, 406, 408, 410, 412,414, 416, 463; CDRL SEQ ID NO: 5, 7, 9, 10, 12, 13, 15, 16, U.S. Pat.No. 8,168,762 B2 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30, 31, 32, 33,35, 36, 37, 38, 39, 40, 42, 44, 46, 405, 407, 409, 411, 413, 415, 417,465; CDRH SEQ ID NO: 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 60,62, 64, 65, 67, 69, 71, 72, 74, 76, 77, 78, 79, 80, 81, 83, 85, 87, 89,91, 404, 406, 408, 410, 412, 414, 416, 463; CDRL SEQ ID NO: 5, 7, 9, 10,12, 13, 15, 16, US20120020976A1 17, 18, 19, 20, 21, 22, 23, 24, 26, 28,30, 31, 32, 33, 35, 36, 37, 38, 39, 40, 42, 44, 46, 222, 229, 238, 405,407, 409, 411, 413, 415, 417; CDRH SEQ ID NO: 47, 48, 49, 50, 51, 52,53, 54, 55, 56, 57, 58, 60, 62, 64, 65, 67, 69, 71, 72, 74, 76, 77, 78,79, 80, 81, 83, 85, 87, 89, 91, 247, 256, 265, 404, 406, 408, 410, 412,414, 416; CDRL SEQ ID NO: 5, 7, 9, 10, 12, 13, 15, 16, US20130085265A117, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30, 31, 32, 33, 35, 36, 37, 38,39, 40, 42, 44, 46, 405, 407, 409, 411, 413, 415, 417, 461, 465, 485;CDRH SEQ ID NO: 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 60, 62,64, 65, 67, 69, 71, 72, 74, 76, 77, 78, 79, 80, 81, 83, 85, 87, 89, 91,404, 406, 408, 410, 412, 414, 416, 459, 463, 483; CDRL SEQ ID NO: 5, 7,9, 10, 12, 13, 15, 16, US20130079501A1 17, 18, 19, 20, 21, 22, 23, 24,26, 28, 30, 31, 32, 33, 35, 36, 37, 38, 39, 40, 42, 44, 46, 405, 407,409, 411, 413, 415, 417, 461, 465, 485; CDRH SEQ ID NO: 47, 48, 49, 50,51, 52, 53, 54, 55, 56, 57, 58, 60, 62, 64, 65, 67, 69, 71, 72, 74, 76,77, 78, 79, 80, 81, 83, 85, 87, 89, 91, 404, 406, 408, 410, 412, 414,416, 459, 463, 483; CDRL SEQ ID NO: 5, 7, 9, 10, 12, 13, 15, 16,US20120213797A1 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30, 31, 32, 33,35, 36, 37, 38, 39, 40, 42, 44, 46, 405, 407, 409, 411, 413, 415, 417,158, 162, 395, 473, 477; CDRH SEQ ID NO: 47, 48, 49, 50, 51, 52, 53, 54,55, 56, 57, 58, 60, 62, 64, 65, 67, 69, 71, 72, 74, 76, 77, 78, 79, 80,81, 83, 85, 87, 89, 91, 404, 406, 408, 410, 412, 414, 416, 180, 175,308, 368, 471, 475; CDRL SEQ ID NO: 5, 7, 9, 10, 12, 13, 15, 16,US20120251544A1 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30, 31, 32, 33,35, 36, 37, 38, 39, 40, 42, 44, 46, 405, 407, 409, 411, 413, 415, 417;CDRH SEQ ID NO: 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 60, 62,64, 65, 67, 69, 71, 72, 74, 76, 77, 78, 79, 80, 81, 83, 85, 87, 89, 91,404, 406, 408, 410, 412, 414, 416; CDRL SEQ ID NO: 5, 7, 9, 10, 12, 13,15, 16, US20130052201A1 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 30, 31,32, 33, 35, 36, 37, 38, 39, 40, 42, 44, 46, 405, 407, 409, 411, 413,415, 417, 461, 465, 485; CDRH SEQ ID NO: 47, 48, 49, 50, 51, 52, 53, 54,55, 56, 57, 58, 60, 62, 64, 65, 67, 69, 71, 72, 74, 76, 77, 78, 79, 80,81, 83, 85, 87, 89, 91, 404, 406, 408, 410, 412, 414, 416, 459, 463,483; CDRL SEQ ID NO: 5, 7, 9, 10, 12, 13, 15, 16, US20130058944A1 17,18, 19, 20, 21, 22, 23, 24, 26, 28, 30, 31, 32, 33, 35, 36, 37, 38, 39,40, 42, 44, 46, 405, 407, 409, 411, 413, 415, 417, 461, 465, 485; CDRHSEQ ID NO: 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 60, 62, 64,65, 67, 69, 71, 72, 74, 76, 77, 78, 79, 80, 81, 83, 85, 87, 89, 91, 404,406, 408, 410, 412, 414, 416, 459, 463, 483; CDRL SEQ ID NO: 5, 7, 9,10, 12, 13, 15, 16, US20130079502A1 17, 18, 19, 20, 21, 22, 23, 24, 26,28, 30, 31, 32, 33, 35, 36, 37, 38, 39, 40, 42, 44, 46, 405, 407, 409,411, 413, 415, 417; CDRH SEQ ID NO: 47, 48, 49, 50, 51, 52, 53, 54, 55,56, 57, 58, 60, 62, 64, 65, 67, 69, 71, 72, 74, 76, 77, 78, 79, 80, 81,83, 85, 87, 89, 91, 404, 406, 408, 410, 412, 414, 416; CDRL SEQ ID NO:5, 7, 9, 10, 12, 13, 15, 16, US20130245235A1 17, 18, 19, 20, 21, 22, 23,24, 26, 28, 30, 31, 32, 33, 35, 36, 37, 38, 39, 40, 42, 44, 46, 405,407, 409, 411, 413, 415, 417; CDRH SEQ ID NO: 47, 48, 49, 50, 51, 52,53, 54, 55, 56, 57, 58, 60, 62, 64, 65, 67, 69, 71, 72, 74, 76, 77, 78,79, 80, 81, 83, 85, 87, 89, 91, 404, 406, 408, 410, 412, 414, 416;

TABLE 9 Human variable & constant variants distributed over severalhuman ethnic populations - useful for ligand tailoring Nucleotide HomHuman Amino Acid Variation² Freq⁷ Gene Example Position (NCBl dbSNPVariant (Het + Segment Human & refeence Nucleotide Human No. Het Hom CumType Allele¹ Variation number)³ Position Populations⁴ Individs⁵ Freq⁶freq⁸) Freq⁹ IGHG1 IGHG1*01 204D GAT 14:106208086 A 153 0.400 0.0960.296 (CH3 (forward strand) (European (0.496) variation) ancestry)IGHG1*03 204E GAG 14:106208086 A 366 0.400 0.504 0.704 (CH3 (rs1045853)(forward strand) (European (0.904) variation) ancestry IGHG1*01 206L CTG14:106208082 A 0.358 0.104 0.283 (CH3 (forward strand) (European (0.462)variation) ancestry) IGHG1*03 206M ATG 14:106208082 A 0.358 0.538 0.717(CH3 (rs11621259) (forward strand) (European (0.896) variation)ancestry) IGHG2 IGHG2*01 72P CCC 14:106110914 B 0.336 0.540 0.708 (CH1(forward strand) (0.876) variation) IGHG2*02 72T ACC 14:106110914 B0.336 0.124 0.292 (CH1 (rs11627594) (forward strand) variation) IGHG2*0175N AAC 14:106110904 A 0.007 0.993 0.997 (CH1 (forward strand)variation) IGHG2*04 75S AGC 14:106110904 A 0.007 0.004 (CH1(rs201590297) (forward strand) variation) IGHG2*01 76F TTC (CH1variation) IGHG2*04 76L TTG (CH1 variation) IGHG2*01 161V GTG14:10611013 B 0.342 0.539 0.711 (CH2 (forward strand) (0.881) variation)IGHG2*02 161M ATG 14:10611013 B 0.342 0.118 0.289 (CH2 (rs8009156)(forward strand) (0.46) variation) IGHG2*01 257A GCC 14:106109752 C0.199 0.493 0.592 (CH3 (forward strand) (0.692) variation) D 0.007 0.9920.995 (0.999) IGHG2*06 257S TCC 14:106109752 C 0.199 0.308 0.408 (CH3(rs4983499) (forward strand) (0.507) variation) D 0.007 0.002 0.005(0.009) IGHG4 IGHG4*01 189L CTG 14:105624992 B 1047 0.315 0.644 0.801(CH2 (forward strand) (0.959) variation) IGHG4*02 189V GTG 14:105624992B 389 0.315 0.041 0.199 (CH2 (rs8015545) (forward strand) (0.356)variation) IGHG4*01 289R AGG 14:105624594 (CH3 (forward strand)variation) IGHG4*03 289K AAG 14:105624594 (CH3 (rs77498506) (forwardstrand) variation) Table Footnotes: ¹IMGT notation (ww.imgt.org); referto figures for other alleles comprising this variation. ²SNP Underlinedin Codon. ³NCBI dbSNP Build 138 released on Apr 25, 2013. ⁴Humanpopulation used for representative variant frequency analysis.Populations A This population included 662 participants of Europeandescent from the ClinSeq project, all of whom had undergone whole-exomesequencing using Agilent's 38Mb or 50Mb capture kit. B 1000 Genomesdatabase. C ESP6500:African_American. D ESP6500:European_American.⁵Number of individuals in representative population found to have theallele. ⁶Heterozygous human genotype frequency, ie, cumulative frequencyof all genotypes having one occurrence of the variant allele and oneoccurrence of another allele (heterozygous state), eg, ac genotype inthe population. ⁷Homozygous human genotype frequency, ie, cumulativefrequency of two occurrences of the variant allele (homozygous state),eg, cc genotype in the population. ⁸Total human genotype frequency, ie,total of heterozygous plus homozygous human genotype frequencies.⁹Cumulative human allele frequency of all occurrences of the variantallele in the population.

TABLE 10 FURTHER SEQUENCES SEQ ID Human NO: AlleleNucleotide/Amino Acid Sequence HEAVY CHAIN ALLELES 41 IGHG1*01gcctccaccaagggcccatcggtcttccccctggcaccctcctccaaga (CH1 + Hinge +gcacctctggg CH2 + CH3 +ggcacagcggccctgggctgcctggtcaaggactacttccccgaaccgg CH − S) tgacggtgtcgtggaactcaggcgccctgaccagcggcgtgcacaccttcccggctgtcc tacagtcctcaggactctactccctcagcagcgtggtgaccgtgccctccagcagcttgg gcacccagacctacatctgcaacgtgaatcacaagcccagcaacaccaaggtggacaaga aagttgagcccaaatcttgtgacaaaactcacacatgcccaccgtgcccagcacctgaac tcctggggggaccgtcagtcttcctcttccccccaaaacccaaggacaccctcatgatct cccggacccctgaggtcacatgcgtggtggtggacgtgagccacgaagaccctgaggtca agttcaactggtacgtggacggcgtggaggtgcataatgccaagacaaagccgcgggagg agcagtacaacagcacgtaccgggtggtcagcgtcctcaccgtcctgcaccaggactggc tgaatggcaaggagtacaagtgcaaggtctccaacaaagccctcccagcccccatcgaga aaaccatctccaaagccaaagggcagccccgagaaccacaggtgtacaccctgcccccat cccgggatgagctgaccaagaaccaggtcagcctgacctgcctggtcaaaggcttctatc ccagcgacatcgccgtggagtgggagagcaatgggcagccggagaacaactacaagacca cgcctcccgtgctggactccgacggctccttcttcctctacagcaagctcaccgtggaca agagcaggtggcagcaggggaacgtcttctcatgctccgtgatgcatgaggctctgcaca accactacacgcagaagagcctctccctgtctccgggtaaa 42ASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSG VHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKVEPKSCDKTHTC PPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHN AKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREP QVYTLPPSR D E LTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFL YSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK D  = position 204 L  = position 206 43IGHG2*01 gcctccaccaagggcccatcggtcttccccctggcgccctgctccagga (CH1 +Hinge + gcacctccgag CH2 + CH3 +agcacagccgccctgggctgcctggtcaaggactacttccccgaaccgg CH − S) tgacggtgtcgtggaactcaggcgctctgaccagcggcgtgcacaccttcccagctgtcc tacagtcctcaggactctactccctcagcagcgtggtgaccgtgccctccagcaacttcg gcacccagacctacacctgcaacgtagatcacaagcccagcaacaccaaggtggacaaga cagttgagcgcaaatgttgtgtcgagtgcccaccgtgcccagcaccacctgtggcaggac cgtcagtcttcctcttccccccaaaacccaaggacaccctcatgatctcccggacccctg aggtcacgtgcgtggtggtggacgtgagccacgaagaccccgaggtccagttcaactggt acgtggacggcgtggaggtgcataatgccaagacaaagccacgggaggagcagttcaaca gcacgttccgtgtggtcagcgtcctcaccgttgtgcaccaggactggctgaacggcaagg agtacaagtgcaaggtctccaacaaaggcctcccagcccccatcgagaaaaccatctcca aaaccaaagggcagccccgagaaccacaggtgtacaccctgcccccatcccgggaggaga tgaccaagaaccaggtcagcctgacctgcctggtcaaaggcttctaccccagcgacatcg ccgtggagtgggagagcaatgggcagccggagaacaactacaagaccacacctcccatgc tggactccgacggctccttcttcctctacagcaagctcaccgtggacaagagcaggtggc agcaggggaacgtcttctcatgctccgtgatgcatgaggctctgcacaaccactacacgc agaagagcctctccctgtctccgggtaaa 44 ASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSS GLYSLSSVVTV P SS NF GTQTYTCNVDHKPSNTKVDKTVERKCCVECPPCPAPPVAGPSVF LFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVQFNWYVDG V EVHNAKTKPREEQFNSTFR VVSVLTVVHQDWLNGKEYKCKVSNKGLPAPIEKTISKTKGQPREPQVYTLPPSREEMTKN QVSLTCLVKGFYPSDI A VEWESNGQPENNYKTTPPMLDSDGSFFLYSKLTVDKSRWQQGN VFSCSVMHEALHNHYTQKSLSLSPGK P  = position 72 N  = position 75F  = position 76 V  = position 161 A  = position 257 45 IGHV1-18*01caggttcagctggtgcagtctggagctgaggtgaagaagcctggggcct cagtgaaggtctcctgcaaggcttctggttacacctttaccagctatggtatcagctggg tgcgacaggcccctggacaagggcttgagtggatgggatggatcagcgcttacaatggta acacaaactatgcacagaagctccagggcagagtcaccatgaccacagacacatccacga gcacagcctacatggagctgaggagcctgagatctgacgacacggccgtgtattactgtg cgagaga 46QVQLVQSGAEVKKPGASVKVSCKASGYTFTSYGISWVRQAPGQGLEWMGWISAYNGNTNYAQKLQGRVTMTTDTSTSTAYMELRSLRSDD TAVYYCAR 47IGHV1-46*01 caggtgcagctggtgcagtctggggctgaggtgaagaagcctggggcctcagtgaaggtt tcctgcaaggcatctggatacaccttcaccagctactatatgcactgggtgcgacaggcc cctggacaagggcttgagtggatgggaataatcaaccctagtggtggtagcacaagctac gcacagaagttccagggcagagtcaccatgaccagggacacgtccacgagcacagtctac atggagctgagcagcctgagatctgaggacacggccgtgtattactgtg cgagaga 48QVQLVQSGAEVKKPGASVKVSCKASGYTFTSYYMHWVRQAPGQGLEWMGIINPSGGSTSYAQKFQGRVTMTRDTSTSTVYMELSSLRSED TAVYYCARLIGHT CHAIN ALLELES 49 IGKC*01cgaactgtggctgcaccatctgtcttcatcttcccgccatctgatgagc agttgaaatctggaactgcctctgttgtgtgcctgctgaataacttctatcccagagagg ccaaagtacagtggaaggtggataacgccctccaatcgggtaactcccaggagagtgtca cagagcaggacagcaaggacagcacctacagcctcagcagcaccctgacgctgagcaaag cagactacgagaaacacaaagtctacgcctgcgaagtcacccatcagggcctgagctcgc ccgtcacaaagagcttcaacaggggagagtgt 50RTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQS GNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHK V YA C EVTHQGLSSPVTKSFNRGEC V  = position 84 C = position 87 51 IGLC2*01ggtcagcccaaggctgccccctcggtcactctgttcccgccctcctctg aggagcttcaagccaacaaggccacactggtgtgtctcataagtgacttctacccgggag ccgtgacagtggcttggaaagcagatagcagccccgtcaaggcgggagtggagaccacca caccctccaaacaaagcaacaacaagtacgcggccagcagctatctgagcctgacgcctg agcagtggaagtcccacagaagctacagctgccaggtcacgcatgaagggagcaccgtgg agaagacagtggcccctacagaatgttca 52 GQPKAAPSVTLFPPSSEELQANKATLVCLISDFYPGAVTVAWKADSSPVKAGVETTTPSK QSNNKYAASSYLSLTPEQWKSHRSYSCQVTHEGSTVEKTVAPTECS 53 IGKV4-1*01atggtgttgcagacccaggtcttcatttctctgttgctctggatctctg gtgcctacggggacatcgtgatgacccagtctccagactccctggctgtgtctctgggcg agagggccaccatcaactgcaagtccagccagagtgttttatacagctccaacaataaga actacttagcttggtaccagcagaaaccaggacagcctcctaagctgctcatttactggg catctacccgggaatccggggtccctgaccgattcagtggcagcgggtctgggacagatt tcactctcaccatcagcagcctgcaggctgaagatgtggcagtttattactgtcagcaat attatagtact cctcc 54DIVMTQSPDSLAVSLGERATINCKSSQSVLYSSNNKNYLAWYQQKPGQPPKLLIYWASTRESGVPDRFSGSGSGTDFTLTISSLQAEDV AVYYCQQYYST P 55IGKV1-13*02 atggacatgagggtccccgctcagctcctggggcttctgctgctctggctcccagcaggt gccagatgtgccatccagttgacccagtctccatcctccctgtctgcatctgtaggagac agagtcaccatcacttgccgggcaagtcagggcattagcagtgctttagcctggtatcag cagaaaccagggaaagctcctaagctcctgatctatgatgcctccagtttggaaagtggg gtcccatcaaggttcagcggcagtggatctgggacagatttcactctcaccatcagcagc ctgcagcctgaagattttgcaacttattactgtcaacagtttaatagttaccctcagtgc cagatgtgccatccagttgacccagtctccatcctccctgtctgcatctgtaggagacag agtcaccatcacttgccgggcaagtcagggcattagcagtgctttagcctggtatcagca gaaaccagggaaagctcctaagctcctgatctatgatgcctccagtttggaaagtggggt cccatcaaggttcagcggcagtggatctgggacagatttcactctcaccatcagcagcct gcagcctgaagattttgcaacttattactgtcaacagtttaatagttac cctca 57IGKJ2*01 tgtacacttttggccaggggaccaagctggagatcaaac 58 YTFGQGTKLEIK 59IGLJ2*01 tgtggtattcggcggagggaccaagctgaccgtcctag 60 VVFGGGTKLTVL 61An IGHG1*01 ASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGHeavy Chain VHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKV ConstantEPKSCDKTHTCPPCPAPELLGGPS RegionVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAK TKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQV YTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPG 62 An IGKC*01RTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQS Kappa LightGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPV Chain TKSFNRGECConstant Region 63 An IGHG2*01ASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWNSGALTSG Heavy ChainVHTFPAVLQSSGLYSLSSVVTVPSSNFGTQTYTCNVDHKPSNTKVDKTV ConstantERKCCVECPPCPAPPVAGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSH RegionEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTFRVVSVLTVVHQDWLNGKEYKCKVSNKGLPAPIEKTISKTKGQPREPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPMLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK 64 An IGLC2*01QPKAAPSVTLFPPSSEELQANKATLVCLISDFYPGAVTVAWKADSSPVK LambdaAGVETTTPSKQSNNKYAASSYLSLTPEQWKSHRSYSCQVTHEGSTVEKT Light Chain VAPTECSConstant Region 65 An IGHG2*01ASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWNSGALTSG Heavy ChainVHTFPAVLQSSGLYSLSSVVTVPSSNFGTQTYTCNVDHKPSNTKVDKTV ConstantERKCCVECPPCPAPPVAGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSH RegionEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTFRVVSVLTVVHQDWLNGKEYKCKVSNKGLPSSIEKTISKTKGQPREPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPMLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK 66 An IGKC*01RTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQS Kappa LightGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPV Chain TKSFNRGECConstant Region HUMAN IL4Ra SEQUENCES 67 Amino AcidMGWLCSGLLFPVSCLVLLQVASSGNMKVLQEPTCVSDYMSISTCEWKMNGPTNC SequenceSTELRLLYQLVFLLSEAHTC I PENNGGAGCVCHLLMDDVVSADNYTLDLWAGQQLLWKGSFKPSEHVKPRAPGNLTVHTNVSDTLLLTWSNPYPPDNYLYNHLTYAVNIWSENDPADFRIYNVTYLEPSLRIAASTLKSGISYRARVRAWAQCYNTTWSEWSPSTKWHNSYREPFEQHLLLGVSVSCIVILAVCLLCYVSITKIKKEWWDQIPNPARSRLVAIIIQDAQGSQWEKRSRGQEPAKCPHWKNCLTKLLPCFLEHNMKRDEDPHKAAKEMPFQGSGKSAWCPVEISKTVLWPESISVVRCVELFEAPVECEEEEEVEEEKGSFCASPESSRDDFQEGR E GIVARLTESLFLDLLGEENGGFCQQDMGES C LLPPSGSTSAHMPWDEFPSAGPKEAPPWGKEQPLHLEPSPPASPTQSPDNLTCTE TPLVIAGNPAYRSFSNS LSQSPCPRELGPDPLLARHLEEVEPEMPCVPQLSEPTTVPQPEPETWEQILRRNVLQHGAAAAPVSAPTSGY Q EFVHAVEQGGTQASAVVGLGPPGEAGYKAFSSLLASSAVSPEKCGFGASSGEEGYKPFQDLIPGCPGDPAPVPVPLFTFGLDREPPRSPQSSHLPSSSPEHLGLEPGEKVEDMPKPPLPQEQATDPLVDSLGSGIVYSALTCHLCGHLKQCHGQEDGGQTPVMASPCCGCCCGDR S SPPTTPLRAPDPSPGGVPLEASLCPASLAPSGISEKSKSSSSFHPAPGNAQSSSQTPK IVNFVSVGPTYMRVS I = position 75 E  = position 400 C  = position 431 S  = position 503 Q = position 576 S  = position 752 68 NucleotideATGGGGTGGCTTTGCTCTGGGCTCCTGTTCCCTGTGAGCTGCCTGGTCCTGCTG SequenceCAGGTGGCAAGCTCTGGGAACATGAAGGTCTTGCAGGAGCCCACCTGCGTCTCCGACTACATGAGCATCTCTACTTGCGAGTGGAAGATGAATGGTCCCACCAATTGCAGCACCGAGCTCCGCCTGTTGTACCAGCTGGTTTTTCTGCTCTCCGAAGCCCACACGTGTATCCCTGAGAACAACGGAGGCGCGGGGTGCGTGTGCCACCTGCTCATGGATGACGTGGTCAGTGCGGATAACTATACACTGGACCTGTGGGCTGGGCAGCAGCTGCTGTGGAAGGGCTCCTTCAAGCCCAGCGAGCATGTGAAACCCAGGGCCCCAGGAAACCTGACAGTTCACACCAATGTCTCCGACACTCTGCTGCTGACCTGGAGCAACCCGTATCCCCCTGACAATTACCTGTATAATCATCTCACCTATGCAGTCAACATTTGGAGTGAAAACGACCCGGCAGATTTCAGAATCTATAACGTGACCTACCTAGAACCCTCCCTCCGCATCGCAGCCAGCACCCTGAAGTCTGGGATTTCCTACAGGGCACGGGTGAGGGCCTGGGCTCAGTGCTATAACACCACCTGGAGTGAGTGGAGCCCCAGCACCAAGTGGCACAACTCCTACAGGGAGCCCTTCGAGCAGCACCTCCTGCTGGGCGTCAGCGTTTCCTGCATTGTCATCCTGGCCGTCTGCCTGTTGTGCTATGTCAGCATCACCAAGATTAAGAAAGAATGGTGGGATCAGATTCCCAACCCAGCCCGCAGCCGCCTCGTGGCTATAATAATCCAGGATGCTCAGGGGTCACAGTGGGAGAAGCGGTCCCGAGGCCAGGAACCAGCCAAGTGCCCACACTGGAAGAATTGTCTTACCAAGCTCTTGCCCTGTTTTCTGGAGCACAACATGAAAAGGGATGAAGATCCTCACAAGGCTGCCAAAGAGATGCCTTTCCAGGGCTCTGGAAAATCAGCATGGTGCCCAGTGGAGATCAGCAAGACAGTCCTCTGGCCAGAGAGCATCAGCGTGGTGCGATGTGTGGAGTTGTTTGAGGCCCCGGTGGAGTGTGAGGAGGAGGAGGAGGTAGAGGAAGAAAAAGGGAGCTTCTGTGCATCGCCTGAGAGCAGCAGGGATGACTTCCAGGAGGGAAGGGAGGGCATTGTGGCCCGGCTAACAGAGAGCCTGTTCCTGGACCTGCTCGGAGAGGAGAATGGGGGCTTTTGCCAGCAGGACATGGGGGAGTCATGCCTTCTTCCACCTTCGGGAAGTACGAGTGCTCACATGCCCTGGGATGAGTTCCCAAGTGCAGGGCCCAAGGAGGCACCTCCCTGGGGCAAGGAGCAGCCTCTCCACCTGGAGCCAAGTCCTCCTGCCAGCCCGACCCAGAGTCCAGACAACCTGACTTGCACAGAGACGCCCCTCGTCATCGCAGGCAACCCTGCTTACCGCAGCTTCAGCAACTCCCTGAGCCAGTCACCGTGTCCCAGAGAGCTGGGTCCAGACCCACTGCTGGCCAGACACCTGGAGGAAGTAGAACCCGAGATGCCCTGTGTCCCCCAGCTCTCTGAGCCAACCACTGTGCCCCAACCTGAGCCAGAAACCTGGGAGCAGATCCTCCGCCGAAATGTCCTCCAGCATGGGGCAGCTGCAGCCCCCGTCTCGGCCCCCACCAGTGGCTATCAGGAGTTTGTACATGCGGTGGAGCAGGGTGGCACCCAGGCCAGTGCGGTGGTGGGCTTGGGTCCCCCAGGAGAGGCTGGTTACAAGGCCTTCTCAAGCCTGCTTGCCAGCAGTGCTGTGTCCCCAGAGAAATGTGGGTTTGGGGCTAGCAGTGGGGAAGAGGGGTATAAGCCTTTCCAAGACCTCATTCCTGGCTGCCCTGGGGACCCTGCCCCAGTCCCTGTCCCCTTGTTCACCTTTGGACTGGACAGGGAGCCACCTCGCAGTCCGCAGAGCTCACATCTCCCAAGCAGCTCCCCAGAGCACCTGGGTCTGGAGCCGGGGGAAAAGGTAGAGGACATGCCAAAGCCCCCACTTCCCCAGGAGCAGGCCACAGACCCCCTTGTGGACAGCCTGGGCAGTGGCATTGTCTACTCAGCCCTTACCTGCCACCTGTGCGGCCACCTGAAACAGTGTCATGGCCAGGAGGATGGTGGCCAGACCCCTGTCATGGCCAGTCCTTGCTGTGGCTGCTGCTGTGGAGACAGGTCCTCGCCCCCTACAACCCCCCTGAGGGCCCCAGACCCCTCTCCAGGTGGGGTTCCACTGGAGGCCAGTCTGTGTCCGGCCTCCCTGGCACCCTCGGGCATCTCAGAGAAGAGTAAATCCTCATCATCCTTCCATCCTGCCCCTGGCAATGCTCAGAGCTCAAGCCAGACCCCCAAAATCGTGAACTTTGTCTCCGTGGGACCCACATACATGAGGGTCTCTTAGANTI-HUMAN IL4Ra ANTIBODY SEQUENCES 69 VHEVQLVESGGG LEQPGGSLRLSCAGSGFTFR DYAMTWVRQA PGKGLEWVSSISGSGGNTYY ADSVKGRFTISRDNSKNTLY LQMNSLRAEDTAVYYCAKDRLSITIRPRYYGLDVWGQGTTVTVSS 70 VLDIVMTQSPLSLPVTPGEPASISCRSSQSLLYSIGYNYLDWYLQKSGQSPQLLIYLGSNRASGVPDRFSGSGSGTDFTLKISRVEAEDVGFYYCMQALQTP YTFGQGTKLEIK 71HEAVY CHAIN EVQLVESGGG LEQPGGSLRL SCAGSGFTFR DYAMTWVRQA PGKGLEWVSSISGSGGNTYY ADSVKGRFTI SRDNSKNTLY LQMNSLRAED TAVYYCAKDRLSITIRPRYY GLDVWGQGTT VTVSSASTKG PSVFPLAPCS RSTSESTAALGCLVKDYFPE PVTVSWNSGA LTSGVHTFPA VLQSSGLYSL SSVVTVPSSSLGTKTYTCNV DHKPSNTKVD KRVESKYGPP CPPCPAPEFL GGPSVFLFPPKPKDTLMISR TPEVTCVVVD VSQEDPEVQF NWYVDGVEVH NAKTKPREEQFNSTYRVVSV LTVLHQDWLN GKEYKCKVSN KGLPSSIEKT ISKAKGQPREPQVYTLPPSQ EEMTKNQVSL TCLVKGFYPS DIAVEWESNG QPENNYKTTPPVLDSDGSFF LYSRLTVDKS RWQEGNVFSC SVMHEALHNH YTQKSLSLSL G 72 LIGHT CHAINDIVMTQSPLSLPVTPGEPASISCRSSQSLLYSIGYNYLDWYLQKSGQSPQLLIYLGSNRASGVPDRFSGSGSGTDFTLKISRVEAEDVGFYYCMQALQTPYTFGQGTKLEIKRTVAAPSV FIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACE VTHQGLSSPVTKSFHUMAN IGHG4 SEQUENCES 73 IGHG4*01ASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWNSGALTSG AMINO ACIDVHTFPAVLQSSGLYSLSSVVTVPSSSLGTKTYTCNVDHKPSNTKVDKRV SEQUENCEESKYGPPCPSCPAPEFLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSQEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTYRVVSVLTV L HQDWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYS R LTVDKSRWQEGNVFSCSVMHEALHNHYTQKSLSLSLGK L  = position 189 R  = postion 289 74IGHG4*01 GCTTCCACCAAGGGCCCATCGGTCTTCCCCCTGGCGCCCTGCTCCAGGA NUCLEOTIDEGCACCTCCGAGAGCACAGCCGCCCTGGGCTGCCTGGTCAAGGACTACTT SEQUENCECCCCGAACCGGTGACGGTGTCGTGGAACTCAGGCGCCCTGACCAGCGGCGTGCACACCTTCCCGGCTGTCCTACAGTCCTCAGGACTCTACTCCCTCAGCAGCGTGGTGACCGTGCCCTCCAGCAGCTTGGGCACGAAGACCTACACCTGCAACGTAGATCACAAGCCCAGCAACACCAAGGTGGACAAGAGAGTTGAGTCCAAATATGGTCCCCCATGCCCATCATGCCCAGCACCTGAGTTCCTGGGGGGACCATCAGTCTTCCTGTTCCCCCCAAAACCCAAGGACACTCTCATGATCTCCCGGACCCCTGAGGTCACGTGCGTGGTGGTGGACGTGAGCCAGGAAGACCCCGAGGTCCAGTTCAACTGGTACGTGGATGGCGTGGAGGTGCATAATGCCAAGACAAAGCCGCGGGAGGAGCAGTTCAACAGCACGTACCGTGTGGTCAGCGTCCTCACCGTC C TGCACCAGGACTGGCTGAACGGCAAGGAGTACAAGTGCAAGGTCTCCAACAAAGGCCTCCCGTCCTCCATCGAGAAAACCATCTCCAAAGCCAAAGGGCAGCCCCGAGAGCCACAGGTGTACACCCTGCCCCCATCCCAGGAGGAGATGACCAAGAACCAGGTCAGCCTGACCTGCCTGGTCAAAGGCTTCTACCCCAGCGACATCGCCGTGGAGTGGGAGAGCAATGGGCAGCCGGAGAACAACTACAAGACCACGCCTCCCGTGCTGGACTCCGACGGCTCCTTCTTCCTCTACAGCA G GCTCACCGTGGACAAGAGCAGGTGGCAGGAGGGGAATGTCTTCTCATGCTCCGTGATGCATGAGGCTCTGCACAACCACTACACACAGAAGAGCCTCTCCCTGTCTCTGGGTAA ATGA C  =position 565 ( C TG encodes 189V) G  = position 866 (A G G encodes 289R)Nav1.7 SEQUENCES 75 HUMAN Nav1.7MAMLPPPGPQSFVHFTKQSLALIEQRIAERKSKEPKEEKKDDDEEAPKPSSDLEAG AMINO ACIDKQLPFIYGDIPPGMVSEPLEDLDPYYADKKTFIVLNKGKTIFRFNATPALYMLSPFS SEQUENCEPLRRISIKILVHSLFSMLIMCTILTNCIFMTMNNPPDWTKNVEYTFTGIYTFESLVKI (ENST00000303LARGFCVGEFTFLRDPWNWLDFVVIVFAYLTEFVNLGNVSALRTFRVLRALKTISVI 354)PGLKTIVGALIQSVKKLSDVMILTVFCLSVFALIGLQLFMGNLKHKCFRNSLENNETLESIMNTLESEEDFRKYFYYLEGSKDALLCGFSTDSGQCPEGYTCVKIGRNPDYGYTSFDTFSWAFLALFRLMTQDYWENLYQQTLRAAGKTYMIFFVVVIFLGSFYLINLILAVVAMAYEEQNQANIEEAKQKELEFQQMLDRLKKEQEEAEAIAAAAAEYTSIRRSRIMGLSESSSETSKLSSKSAKERRNRRKKKNQKKLSSGEEKGDAEKLSKSESEDSIRRKSFHLGVEGHRRAHEKRLSTPNQSPLSIRGSLFSARRSSRTSLFSFKGRGRDIGSETEFADDEHSIFGDNESRRGSLFVPHRPQERRSSNISQASRSPPMLPVNGKMHSAVDCNGVVSLVDGRSALMLPNGQLLPEVIIDKATSDDSGTTNQIHKKRRCSSYLLSEDMLNDPNLRQRAMSRASILTNTVEELEESRQKCPPWWYRFAHKFLIWNCSPYWIKFKKCIYFIVMDPFVDLAITICIVLNTLFMAMEHHPMTEEFKNVLAIGNLVFTGIFAAEMVLKLIAMDPYEYFQVGWNIFDSLIVTLSLVELFLADVEGLSVLRSFRLLRVFKLAKSWPTLNMLIKIIGNSVGALGNLTLVLAIIVFIFAVVGMQLFGKSYKECVCKINDDCTLPRWHMNDFFHSFLIVFRVLCGEWIETMWDCMEVAGQAMCLIVYMMVMVIGNLVVLNLFLALLLSSFSSDNLTAIEEDPDANNLQIAVTRIKKGINYVKQTLREFILKAFSKKPKISREIRQAEDLNTKKENYISNHTLAEMSKGHNFLKEKDKISGFGSSVDKHLMEDSDGQSFIHNPSLTVTVPIAPGESDLENMNAEELSSDSDSEYSKVRLNRSSSSECSTVDNPLPGEGEEAEAEPMNSDEPEACFTDGCVWRFSCCQVNIESGKGKIWWNIRKTCYKIVEHSWFESFIVLMILLSSGALAFEDIYIERKKTIKIILEYADKIFTYIFILEMLLKWIAYGYKTYFTNAWCWLDFLIVDVSLVTLVANTLGYSDLGPIKSLRTLRALRPLRALSRFEGMRVVVNALIGAIPSIMNVLLVCLIFWLIFSIMGVNLFAGKFYECINTTDGSRFPASQVPNRSECFALMNVSQNVRWKNLKVNFDNVGLGYLSLLQVATFKGWTIIMYAAVDSVNVDKQPKYEYSLYMYIYFVVFIIFGSFFTLNLFIGVIIDNFNQQKKKLGGQDIFMTEEQKKYYNAMKKLGSKKPQKPIPRPGNKIQGCIFDLVTNQAFDISIMVLICLNMVTMMVEKEGQSQHMTEVLYWINVVFIILFTGECVLKLISLRHYYFTVGWNIFDFVVVIISIVGMFLADLIETYFVSPTLFRVIRLARIGRILRLVKGAKGIRTLLFALMMSLPALFNIGLLLFLVMFIYAIFGMSNFAYVKKEDGINDMFNFETFGNSMICLFQITTSAGWDGLLAPILNSKPPDCDPKKVHPGSSVEGDCGNPSVGIFYFVSYIIISFLVVVNMYIAVILENFSVATEESTEPLSEDDFEMFYEVWEKFDPDATQFIEFSKLSDFAAALDPPLLIAKPNKVQLIAMDLPMVSGDRIHCLDILFAFTKRVLGESGEMDSLRSQMEERFMSANPSKVSYEPITTTLKRKQEDVSATVIQRAYRRYRLRQNVKNISSIYIKDGDRDDDLLNKKDMAFDNVNENSSPEKTDATSSTTSPPSYDSVTKPDKEKYEQDR TEKEDKGKDSKESKK76 HUMAN Nav1.7 ATGGCAATGTTGCCTCCCCCAGGACCTCAGAGCTTTGTCCATTTCACAAAACANUCLEOTIDE GTCTCTTGCCCTCATTGAACAACGCATTGCTGAAAGAAAATCAAAGGAACCCASEQUENCE AAGAAGAAAAGAAAGATGATGATGAAGAAGCCCCAAAGCCAAGCAGTGACT(ENST00000303 TGGAAGCTGGCAAACAGCTGCCCTTCATCTATGGGGACATTCCTCCCGGCATG 354)GTGTCAGAGCCCCTGGAGGACTTGGACCCCTACTATGCAGACAAAAAGACTTTCATAGTATTGAACAAAGGGAAAACAATCTTCCGTTTCAATGCCACACCTGCTTTATATATGCTTTCTCCTTTCAGTCCTCTAAGAAGAATATCTATTAAGATTTTAGTACACTCCTTATTCAGCATGCTCATCATGTGCACTATTCTGACAAACTGCATATTTATGACCATGAATAACCCACCGGACTGGACCAAAAATGTCGAGTACACTTTTACTGGAATATATACTTTTGAATCACTTGTAAAAATCCTTGCAAGAGGCTTCTGTGTAGGAGAATTCACTTTTCTTCGTGACCCGTGGAACTGGCTGGATTTTGTCGTCATTGTTTTTGCGTATTTAACAGAATTTGTAAACCTAGGCAATGTTTCAGCTCTTCGAACTTTCAGAGTATTGAGAGCTTTGAAAACTATTTCTGTAATCCCAGGCCTGAAGACAATTGTAGGGGCTTTGATCCAGTCAGTGAAGAAGCTTTCTGATGTCATGATCCTGACTGTGTTCTGTCTGAGTGTGTTTGCACTAATTGGACTACAGCTGTTCATGGGAAACCTGAAGCATAAATGTTTTCGAAATTCACTTGAAAATAATGAAACATTAGAAAGCATAATGAATACCCTAGAGAGTGAAGAAGACTTTAGAAAATATTTTTATTACTTGGAAGGATCCAAAGATGCTCTCCTTTGTGGTTTCAGCACAGATTCAGGTCAGTGTCCAGAGGGGTACACCTGTGTGAAAATTGGCAGAAACCCTGATTATGGCTACACGAGCTTTGACACTTTCAGCTGGGCCTTCTTAGCCTTGTTTAGGCTAATGACCCAAGATTACTGGGAAAACCTTTACCAACAGACGCTGCGTGCTGCTGGCAAAACCTACATGATCTTCTTTGTCGTAGTGATTTTCCTGGGCTCCTTTTATCTAATAAACTTGATCCTGGCTGTGGTTGCCATGGCATATGAAGAACAGAACCAGGCAAACATTGAAGAAGCTAAACAGAAAGAATTAGAATTTCAACAGATGTTAGACCGTCTTAAAAAAGAGCAAGAAGAAGCTGAGGCAATTGCAGCGGCAGCGGCTGAATATACAAGTATTAGGAGAAGCAGAATTATGGGCCTCTCAGAGAGTTCTTCTGAAACATCCAAACTGAGCTCTAAAAGTGCTAAAGAAAGAAGAACAGAAGAAAGAAAAAGAATCAAAAGAAGCTCTCCAGTGGAGAGGAAAAGGGAGATGCTGAGAAATTGTCGAAATCAGAATCAGAGGACAGCATCAGAAGAAAAAGTTTCCACCTTGGTGTCGAAGGGCATAGGCGAGCACATGAAAAGAGGTTGTCTACCCCCAATCAGTCACCACTCAGCATTCGTGGCTCCTTGTTTTCTGCAAGGCGAAGCAGCAGAACAAGTCTTTTTAGTTTCAAAGGCAGAGGAAGAGATATAGGATCTGAGACTGAATTTGCCGATGATGAGCACAGCATTTTTGGAGACAATGAGAGCAGAAGGGGCTCACTGTTTGTGCCCCACAGACCCCAGGAGCGACGCAGCAGTAACATCAGCCAAGCCAGTAGGTCCCCACCAATGCTGCCGGTGAACGGGAAAATGCACAGTGCTGTGGACTGCAACGGTGTGGTCTCCCTGGTTGATGGACGCTCAGCCCTCATGCTCCCCAATGGACAGCTTCTGCCAGAGGTGATAATAGATAAGGCAACTTCTGATGACAGCGGCACGACCAATCAAATACACAAGAAAAGGCGTTGTAGTTCCTATCTCCTTTCAGAGGATATGCTGAATGATCCCAACCTCAGACAGAGAGCAATGAGTAGAGCAAGCATATTAACAAACACTGTGGAAGAACTTGAAGAGTCCAGACAAAAATGTCCACCTTGGTGGTACAGATTTGCACACAAATTCTTGATCTGGAATTGCTCTCCATATTGGATAAAATTCAAAAAGTGTATCTATTTTATTGTAATGGATCCTTTTGTAGATCTTGCAATTACCATTTGCATAGTTTTAAACACATTATTTATGGCTATGGAACACCACCCAATGACTGAGGAATTCAAAAATGTACTGCTATAGGAAATTTGGTCTTTACTGGAATCTTTGCAGCTGAAATGGTATTAAAACTGATTGCCATGGATCCATATGAGTATTTCCAAGTAGGCTGGAATATTTTTGACAGCCTTATTGTGACTTTAAGTTTAGTGGAGCTCTTTCTAGCAGATGTGGAAGGATTGTCAGTTCTGCGATCATTCAGACTGCTCCGAGTCTTCAAGTTGGCAAAATCCTGGCCAACATTGAACATGCTGATTAAGATCATTGGTAACTCAGTAGGGGCTCTAGGTAACCTCACCTTAGTGTTGGCCATCATCGTCTTCATTTTTGCTGTGGTCGGCATGCAGCTCTTTGGTAAGAGCTACAAAGAATGTGTCTGCAAGATCAATGATGACTGTACGCTCCCACGGTGGCACATGAACGACTTCTTCCACTCCTTCCTGATTGTGTTCCGCGTGCTGTGTGGAGAGTGGATAGAGACCATGTGGGACTGTATGGAGGTCGCTGGTCAAGCTATGTGCCTTATTGTTTACATGATGGTCATGGTCATTGGAAACCTGGTGGTCCTAAACCTATTTCTGGCCTTATTATTGAGCTCATTTAGTTCAGACAATCTTACAGCAATTGAAGAAGACCCTGATGCAAACAACCTCCAGATTGCAGTGACTAGAATTAAAAAGGGAATAAATTATGTGAAACAAACCTTACGTGAATTTATTCTAAAAGCATTTTCCAAAAAGCCAAAGATTTCCAGGGAGATAAGACAAGCAGAAGATCTGAATACTAAGAAGGAAAACTATATTTCTAACCATACACTTGCTGAAATGAGCAAAGGTCACAATTTCCTCAAGGAAAAAGATAAAATCAGTGGTTTTGGAAGCAGCGTGGACAAACACTTGATGGAAGACAGTGATGGTCAATCATTTATTCACAATCCCAGCCTCACAGTGACAGTGCCAATTGCACCTGGGGAATCCGATTTGGAAAATATGAATGCTGAGGAACTTAGCAGTGATTCGGATAGTGAATACAGCAAAGTGAGATTAAACCGGTCAAGCTCCTCAGAGTGCAGCACAGTTGATAACCCTTTGCCTGGAGAAGGAGAAGAAGCAGAGGCTGAACCTATGAATTCCGATGAGCCAGAGGCCTGTTTCACAGATGGTTGTGTATGGAGGTTCTCATGCTGCCAAGTTAACATAGAGTCAGGGAAAGGAAAAATCTGGTGGAACATCAGGAAAACCTGCTACAAGATTGTTGAACACAGTTGGTTTGAAAGCTTCATTGTCCTCATGATCCTGCTCAGCAGTGGTGCCCTGGCTTTTGAAGATATTTATATTGAAAGGAAAAAGACCATTAAGATTATCCTGGAGTATGCAGACAAGATCTTCACTTACATCTTCATTCTGGAAATGCTTCTAAAATGGATAGCATATGGTTATAAAACATATTTCACCAATGCCTGGTGTTGGCTGGATTTCCTAATTGTTGATGTTTCTTTGGTTACTTTAGTGGCAAACACTCTTGGCTACTCAGATCTTGGCCCCATTAAATCCCTTCGGACACTGAGAGCTTTAAGACCTCTAAGAGCCTTATCTAGATTTGAAGGAATGAGGGTCGTTGTGAATGCACTCATAGGAGCAATTCCTTCCATCATGAATGTGCTACTTGTGTGTCTTATATTCTGGCTGATATTCAGCATCATGGGAGTAAATTTGTTTGCTGGCAAGTTCTATGAGTGTATTAACACCACAGATGGGTCACGGTTTCCTGCAAGTCAAGTTCCAAATCGTTCCGAATGTTTTGCCCTTATGAATGTTAGTCAAAATGTGCGATGGAAAAACCTGAAAGTGAACTTTGATAATGTCGGACTTGGTTACCTATCTCTGCTTCAAGTTGCAACTTTTAAGGGATGGACGATTATTATGTATGCAGCAGTGGATTCTGTTAATGTAGACAAGCAGCCCAAATATGAATATAGCCTCTACATGTATATTTATTTTGTCGTCTTTATCATCTTTGGGTCATTCTTCACTTTGAACTTGTTCATTGGTGTCATCATAGATAATTTCAACCAACAGAAAAAGAAGCTTGGAGGTCAAGACATCTTTATGACAGAAGAACAGAAGAAATACTATAATGCAATGAAAAAGCTGGGGTCCAAGAAGCCACAAAAGCCAATTCCTCGACCAGGGAACAAAATCCAAGGATGTATATTTGACCTAGTGACAAATCAAGCCTTTGATATTAGTATCATGGTTCTTATCTGTCTCAACATGGTAACCATGATGGTAGAAAAGGAGGGTCAAAGTCAACATATGACTGAAGTTTTATATTGGATAAATGTGGTTTTTATAATCCTTTTCACTGGAGAATGTGTGCTAAAACTGATCTCCCTCAGACACTACTACTTCACTGTAGGATGGAATATTTTTGATTTTGTGGTTGTGATTATCTCCATTGTAGGTATGTTTCTAGCTGATTTGATTGAAACGTATTTTGTGTCCCCTACCCTGTTCCGAGTGATCCGTCTTGCCAGGATTGGCCGAATCCTACGTCTAGTCAAAGGAGCAAAGGGGATCCGCACGCTGCTCTTTGCTTTGATGATGTCCCTTCCTGCGTTGTTTAACATCGGCCTCCTGCTCTTCCTGGTCATGTTCATCTACGCCATCTTTGGAATGTCCAACTTTGCCTATGTTAAAAAGGAAGATGGAATTAATGACATGTTCAATTTTGAGACCTTTGGCAACAGTATGATTTGCCTGTTCCAAATTACAACCTCTGCTGGCTGGGATGGATTGCTAGCACCTATTCTTAACAGTAAGCCACCCGACTGTGACCCAAAAAAAGTTCATCCTGGAAGTTCAGTTGAAGGAGACTGTGGTAACCCATCTGTTGGAATATTCTACTTTGTTAGTTATATCATCATATCCTTCCTGGTTGTGGTGAACATGTACATTGCAGTCATACTGGAGAATTTTAGTGTTGCCACTGAAGAAAGTACTGAACCTCTGAGTGAGGATGACTTTGAGATGTTCTATGAGGTTTGGGAGAAGTTTGATCCCGATGCGACCCAGTTTATAGAGTTCTCTAAACTCTCTGATTTTGCAGCTGCCCTGGATCCTCCTCTTCTCATAGCAAAACCCAACAAAGTCCAGCTCATTGCCATGGATCTGCCCATGGTTAGTGGTGACCGGATCCATTGTCTTGACATCTTATTTGCTTTTACAAAGCGTGTTTTGGGTGAGAGTGGGGAGATGGATTCTCTTCGTTCACAGATGGAAGAAAGGTTCATGTCTGCAAATCCTTCCAAAGTGTCCTATGAACCCATCACAACCACACTAAAACGGAAACAAGAGGATGTGTCTGCTACTGTCATTCAGCGTGCTTATAGACGTTACCGCTTAAGGCAAAATGTCAAAAATATATCAAGTATATACATAAAAGATGGAGACAGAGATGATGATTTACTCAATAAAAAAGATATGGCTTTTGATAATGTTAATGAGAACTCAAGTCCAGAAAAAACAGATGCCACTTCATCCACCACCTCTCCACCTTCATATGATAGTGTAACAAAGCCAGACAAAGAGAAATATGAACAAGACAGAACAGAAAAGGAAGACAAAGGGAAAGACAGCAAGGAAAGCAAAAAATAG

TABLE 11 Human IL4Ra variants distributed over several human ethnicpopulations & having desired total human genotype frequency (a) Aminoacid variability, population distributions and frequencies: Hom Freq⁴No. No. Unique (Het + Hom Human Populations Individs¹ Pops² Het Freq³freq⁵) Cum Freq⁶ Most  75I 835 0.462 0.302 0.533 common (0.764) Variant 75V ASW, CEU, CHB, CHS, 762 14 0.462 0.235 0.467 CLM, FIN, BR, IBS,(0.697) JPT, LWK, MXL, PUR, TSI, YRI Most 400E 988 0.256 0.648 0.777common (0.904) Variant 400A ASW, CEU, CHB, CHS, 384 14 0.256 0.095 0.223CLM, FIN, GBR, IBS, (0.351) JPT, LWK, MXL, PUR, TSI, YRI Most 431C 10770.176 0.810 0.898 common (0.986) Variant 431R ASW, CEU, CHB, CHS, 207 140.176 0.014 0.102 CLM, FIN, GBR, IBS, (0.19) JPT, LWK, MXL, PUR, TSI,YRI Most 5035 1010 0.269 0.656 0.79 common (0.925) Variant 503P ASW,CEU, CHB, CHS, 376 14 0.269 0.075 0.21 CLM, FIN, GBR, IBS, (0.344) JPT,LWK, MXL, PUR, TSI, YRI Most 576Q 885 0.311 0.499 0.655 common (0.81)Variant 576R ASW, CEU, CHB, CHS, 547 14 0.311 0.190 0.345 CLM, FIN, GBR,IBS, (0.501) JPT, LWK, MXL, PUR, TSI, YRI Most 7525 1059 0.176 0.7940.882 common (0.97) Variant 752A ASW, CEU, CHB, CHS, 225 14 0.176 0.0300.118 CLM, FIN, GBR, IBS, (0.206) JPT, LWK, MXL, PUR, TSI, YRI TableFootnotes: ¹Number of individuals in 1000 Genomes database (20110521)found to have the allele; ²Number of unique human ethnic populations in1000 Genomes database in which the allele was found to occur;³Heterozygous human genotype frequency, ie, cumulative frequency of allgenotypes having one occurrence of the variant allele and one occurrenceof another allele (heterozygous state), eg, ac genotype in 1000 Genomesdatabase; ⁴Homozygous human genotype frequency, ie, cumulative frequencyof two occurrences of the variant allele (homozygous state), eg, ccgenotype in 1000 Genomes database; and ⁵Total human genotype frequency,ie, total of heterozygous plus homozygous human genotype frequencies.⁶Cumulative human allele frequency of all occurrences of the variantallele in 1000 Genomes database. (b) Nucleotide Sequence Variations ofSelected Alleles Common A A T T A T Allele Variant Allele NucleotidePosition¹ 16:27344882 16:27362551 16:27362643 16:27362859 16:2736307916:27363606 Non-Synonymous Nucleotide Variation² G C C C G G Variant ID³rs1805010 rs1805011 rs1805012 rs1805015 rs1801275 rs1805016Corresponding Amino Acid Variation 75V 400A 431R 503P 576R 752A TableFootnotes: ¹Notation is chromosome number (all positions are on humanchromosome 1): coordinate number (Ensembl release 73 - September 2013,Genome assembly: GRCh37 (GCA_000001405.13), (forward strand);²Nucleotide change (compared to most common allele) giving rise to anamino acid change in the variant form (compared to most common allele);and ³NCBI dbSNP reference number (NCBI dbSNP Build 138 released on Apr.25, 2013).

TABLE 12 Human Nav1.7 (SCN9A) variants distributed over several humanethnic populations & having desired total human genotype frequency (a)Amino acid variability, population distributions and frequencies: No.Hom Freq⁴ No. Unique (Het + Hom Human Populations Indvids¹ Pops² HetFreq³ freq⁵) Cum Freq⁶ VARIANTS ASSOCIATED WITH PRIMARY ERYTHERMALGIA(PE)⁷ Most 136V common Variant 136I Most 216F common Variant 216S Most241S common Variant 241T Most 395N common Variant 395K Most 848I commonVariant 848T Most 858L common Variant 858H 858F Most 863A common Variant863P Most 1449F common Variant 1449V VARIANTS ASSOCIATED WITH PAROXYSMALEXTREME PAIN DISORDER (PEPD)⁷ Most 996R common Variant 996C Most 1298Vcommon Variant 1298F 1298D Most 1299V common Variant 1299F Most 1461Icommon Variant 1461T Most 1462F common Variant 1462V Most 1464T commonVariant 1464I Most 1627M common Variant 1627K VARIANTS ASSOCIATED WITHCHANNELOPATHY-ASSOCIATED INSENSITIVITY TO PAIN (CIP)⁷ Most 277R commonVariant 277X⁸ Most 328Y common Variant 328X Most 395N common Variant395K Most 459S common Variant 459X Most 693E common Variant 693X Most767I common Variant 767X Most 830R common Variant 830X Most 897W commonVariant 897X Most 1200F common Variant 1200L Most 1235I common Variant1235L Most 1488R common Variant 1488X most 1659K common Variant 1659XMost 1689W common Variant 1689X FURTHER VARIANTS Most 422E 962 0.4420.439 0.660 common (0.881) Variant 422D ASW, CEU, CHB, CHS, 613 14 0.4420.119 0.340 CLM, FIN, GBR, IBS, (0.561) JPT, LWK, MXL, PUR, TSI, YRIMost 490S 1086 0.076 0.918 0.957 common (0.994) Variant 490N ASW, CEU,CHB, CHS, 89 14 0.076 0.005 0.043 CLM, FIN, GBR, IBS, (0.081) JPT, LWK,MXL, PUR, TSI , YRI Most 943M common Variant 943L ASW, CEU, CHB, CHS, 14CLM, FIN, GBR, IBS, JPT, LWK, MXL, PUR, TSI,YRI Most 1161R 1076 0.1890.797 0.891 common (0.986) Variant 1161W ASW, CEU, CHB, CHS, 222 140.189 0.015 0.109 CLM, FIN, GBR, IBS, (0.204) JPT, LWK, MXL, PUR, TSI,YRI Most 1919D 1076 0.109 0.876 0.931 common (0.985) Variant 1919G ASW,CEU, CHB, CHS, 135 14 0.109 0.015 0.069 CLM, FIN, GBR, IBS, (0.124) JPT,LWK, MXL, PUR, TSI,YRI Table Footnotes: ¹Number of individuals in 1000Genomes database (20110521) found to have the allele; ²Number of uniquehuman ethnic populations in 1000 Genomes database in which the allelewas found to occur; ³Heterozygous human genotype frequency, ie,cumulative frequency of all genotypes having one occurrence of thevariant allele and one occurrence of another allele (heterozygousstate), eg, ac genotype in 1000 Genomes database; ⁴Homozygous humangenotype frequency, ie, cumulative frequency of two occurrences of thevariant allele (homozygous state), eg, cc genotype in 1000 Genomesdatabase; and ⁵Total human genotype frequency, ie, total of heterozygousplus homozygous human genotype frequencies. ⁶Cumulative human allelefrequency of all occurrences of the variant allele in 1000 Genomesdatabase. ⁷See J Clin Invest. 2007 Dec;117(12):3603-9, “Mutations insodium-channel gene SCN9A cause a spectrum of human genetic paindisorders”, Drenth JP & Waxman SG (incorporated herein by reference);amino acid position numbering is as per this reference. ⁸X here andelsewhere indicate change to an unknown amino acid (ie, a change fromthe most common amino acid at that position) Amino acid positions are asper Ensembl, unless otherwise indicated. (b) Nucleotide SequenceVariations of Selected Alleles Common G T C C T T Allele VarientNucleotide Position¹ Allele 2:166242648 2:166198883 2:1662864692:166272746 2:166288485 2:166277030 Non-Synonymous Nucleotide Variation²A C T A C G Varient ID³ rs6746030 rs3750904 rs58022607 rs4369876rs13402180 rs12478318 Corresponding Amino Acid Variation 1161W 1919G490N 1002L 422D 943L Table Footnotes: ¹Notation is chromosome number(all positions are on human chromosome 1):coordinate number (Ensemblrelease 73 - September 2013, Genome assembly: GRCh37 (GCA_000001405.13),(forward strand); ²Nucleotide change (compared to most common allele)giving rise to an amino acid change in the variant form (compared tomost common allele); and ³NCBI dbSNP reference number (NCBI dbSNP Build138 released on Apr. 25, 2013).

Example 4 Rarer IL6R Variants

The present invention provides anti-IL6R ligands; and IL6R-binding ortargeting ligands as described herein. The ligands have a variety ofutilities. Some of the ligands, for instance, are useful in specificbinding assays, for genotyping or phenotyping humans, affinitypurification of IL6R, in particular human IL6R or its ligands and inscreening assays to identify other antagonists of IL6R activity. Some ofthe ligands of the invention are useful for inhibiting binding of IL6Rto IL6 and/or gp130, or inhibiting IL6R-mediated activities.

Anti-IL6R ligands (eg, antibodies and anti-sense RNA) have beendeveloped based on targeting and neutralising so-called “wild-type”human IL6R, which is a commonly-occurring form (see, eg, SEQ ID NO: 78).While such therapies are useful for human patients harbouring this formof human IL6R, the inventor considered it useful to investigate thepossibility of targeting rarer—but still naturally-occurring—forms ofIL6R amongst human populations. In this way, the inventor arrived atinsight into the natural occurrences and distributions of rarer humanIL6R forms that can serve as useful targets (at the protein or nucleicacid level) for human treatment, prophylaxis and diagnosis pertinent todiseases and conditions mediated or associated with IL6R activity. Thisparticularly provides for tailored therapies, prophylaxis and diagnosisin humans that are devoid of the common IL6R gene or protein.

The skilled person will know that SNPs or other changes that translateinto amino acid variation can cause variability in activity and/orconformation of human targets to be addressed. This has spawned greatinterest in personalized medicine where genotyping and knowledge ofprotein and nucleotide variability is used to more effectively tailormedicines and diagnosis of patients. The invention, therefore, providesfor tailored pharmaceuticals and testing that specifically addressesrarer IL6R polymorphic variant forms. Such forms or “alleles” (at thenucleotide level), comprise one or more changes at the nucleotide andamino acid levels from the corresponding common form nucleotide andamino acids sequences, ie, there are one or more non-synonymous changesat the nucleotide level that translate into one or more correspondingchanges in the protein target in humans.

Furthermore, the inventor surprisingly realised that the rarer naturalforms, although present in humans at much lower frequencies than thecommon form, nevertheless are represented in multiple andethnically-diverse human populations and usually with many humanexamples per represented ethnic population. Thus, the inventor realisedthat targeting such rarer forms would provide for effective treatment,prophylaxis or diagnosis across many human ethnic populations, therebyextending the utility of the present invention.

With this realisation, the inventor realised that there is significantindustrial and medical application for the invention in terms of guidingthe choice of anti-IL6R ligand for administration to human patients fortherapy and/or prophylaxis of IL6R-mediated or associated diseases orconditions. In this way, the patient receives drugs and ligands that aretailored to their needs—as determined by the patient's genetic orphenotypic makeup. Hand-in-hand with this, the invention provides forthe genotyping and/or phenotyping of patients in connection with suchtreatment, thereby allowing a proper match of drug to patient. Thisincreases the chances of medical efficacy, reduces the likelihood ofinferior treatment using drugs or ligands that are not matched to thepatient (eg, poor efficacy and/or side-effects) and avoidspharmaceutical mis-prescription and waste.

In developing this thinking, in this non-limiting example the presentinventor decided to determine a set of human IL6R variants on the basisof the following criteria, these being criteria that the inventorrealised would provide for useful medical drugs and diagnostics totailored need in the human population. The inventor selected variantshaving at least 3 of the 4 following criteria:—

-   -   Naturally-occurring human IL6R variation having a cumulative        human allele frequency of 35% or less;    -   Naturally-occurring human IL6R variation having a total human        genotype frequency of about 50% or less;    -   Naturally-occurring human IL6R variation found in many different        human ethnic populations (using the standard categorisation of        the 1000 Genomes Project; see Table 14 below); and    -   Naturally-occurring human IL6R variation found in many        individuals distributed across such many different ethnic        populations.

On the basis of these criteria, the inventor identified the variantslisted in Table 13 below. The inventor's selection included, as aconsideration, selection for nucleotide variation that produced aminoacid variation in corresponding IL6R forms (ie, non-synonymousvariations), as opposed to silent variations that do not alter aminoacid residues in the target protein.

TABLE 13 Human IL6R variants distributed over several human ethnicpopulations & having desired total human genotype frequency (a) Aminoacid variability, population distributions and frequencies: Exon 9 HomFreq⁴ No. No. Unique (Het + Hom Human Populations individs¹ Pops² HetFreq³ freq⁵) Cum Freq⁶ Most 358D 0.383 0 489 0.680 common (0.872)Variant 358A YRI, ASW, GBR,TSI, 557 14 0.383 0.128 0.320 CLM, CHB, LWK,CHS, (0.511) MXL, PUR, JPT, IBS, FIN, CEU (See note 7) Most 385V 0.086 0904 0.947 common (0.99) Variant 385I LWK, ASW, YRI, PUR 105 0.086 0.0100.053 (see note 8) (0.096) Table Footnotes: ¹Number of individuals in1000 Genomes database (20110521) found to have the allele; ²Number ofunique human ethnic populations in 1000 Genomes database in which theallele was found to occur; ³Heterozygous human genotype frequency, ie,cumulative frequency of all genotypes having one occurrence of thevariant allele and one occurrence of another allele (heterozygousstate), eg, ac genotype in 1000 Genomes database; ⁴Homozygous humangenotype frequency, ie, cumulative frequency of two occurrences of thevariant allele (homozygous state), eg, cc genotype in 1000 Genomesdatabase; and ⁵Total human genotype frequency, ie, total of heterozygousplus homozygous human genotype frequencies. ⁶Cumulative human allelefrequency of all occurrences of the variant allele in 1000 Genomesdatabase. ⁷According to the 1000 Genomes database version 20130502, thisvariant is found in the following 26 human populations (KHV, GBR, CHB,CDX, CLM, MXL, CHS, JPT, GIH, PUR, ESN, FIN, ACB, BEB, YRI, ASW, ITU,PJL, TSI, PEL, MSL, LWK, STU, GWD, IBS, CEU) and in 1218 individualswith a cumulative frequency of 0.29. ⁸According to the 1000 Genomesdatabase version 20130502, this variant is found in the following 10human populations (ASW, YRI, PEL, MSL, LWK, GWD, PUR, IBS, ESN, ACB) andin 267 individuals with a cumulative frequency of 0.06. (b) NucleotideSequence Variations of Selected Alleles Common Allele A G Varient AlleleNucleotide Position¹ 1:1544262970 1:154427050 Non-Synonymous NucleotideVariation² C A Variant ID³ rs2228145 rs28730736 Corresponding Amino AcidVariation 358A 385I Table Footnotes: ¹Notation is chromosome number (allpositions are on human chromosome 1): coordinate number (Ensembl release73 - September 2013, Genome assembly: GRCh37 ( GCA_000001405.13);²Nucleotide change (compared to most common allele) giving rise to anamino acid change in the variant form (compared to most common allele);and ³NCBI dbSNP reference number (NCBI dbSNP Build 138 released on Apr.25, 2013).

Tailoring Antibodies to Rarer IL6R Variant Profile

As outlined above, the invention includes the possibility to tailortreatment of humans further by selecting antibody-based ligands withvariable and/or constant domains based on gene segments found in manyhumans of the ethnic populations where the variant IL6R forms are foundto meet the selection criteria of the invention. An example is providedfor ligands comprising antibody VH domains derived from recombination ofhuman IGHV gene segments comprising selected nucleotides at positions inthe HCDR1 or FW3 where there is variability in humans (ie, where SNPsoccur in humans).

The inventor analysed human IGHV variation and used this to chooseligands based on human IGHV alleles comprising said selected nucleotidesand for matching to human recipient genotypes and/or phenotypes. Theinventor identified utility in using gene VH gene segments encoding (i)a CDR1 comprising a Phe at position 4 shown in SEQ ID NO: 109 andwherein said human comprises a VH gene segment encoding a CDR1comprising a Phe at position 4 shown in SEQ ID NO: 109, or the humanexpresses VH domains that comprise a CDR1 comprising a Phe at position 4shown in SEQ ID NO: 109; or (ii) a FW3 comprising a Thr at position 33shown in SEQ ID NO: 111 and wherein said human comprises a VH genesegment encoding a FW3 comprising a Thr at position 33 shown in SEQ IDNO: 111 or the human expresses VH domains that comprise a FW3 comprisinga Thr at position 33 shown in SEQ ID NO: 111. Further information isprovided in Table 14, which shows variation at these positions, as wellas the variant distributions across the 1000 Genomes Project databaserelating to many human populations.

In other embodiments, as explained more fully above, the inventionprovides for ligands which are tailored to the human recipient'sgenotype and/or phenotype based on alternative human VH gene segments,or on Vκ, Vλ or constant region gene segments (see further Table 16 forrepresentative variants).

In an example, following this guidance, the chosen ligand can besarilumab.

Further examples, therefore are:—

(i) wherein the ligand comprises a VH domain derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment, and wherein said human comprises a IGHV3-7*01 VHgene segment or the human expresses VH domains derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment.(ii) wherein the ligand comprises a Vκ domain derived from therecombination of human Vκ segment IGKV1-12*01 and a human Jκ segment,and wherein said human comprises a IGKV1-12*01 Vκ gene segment or thehuman expresses Vκ domains derived from the recombination of human Vκsegment IGKV1-12*01 and a human Jκ segment.(iii) wherein the ligand comprises a Vκ domain derived from therecombination of a human Vκ segment and a human Jκ segment, the human Vκsegment encoding (i) a CDR3 comprising a Pro at position 7 shown in SEQID NO: 113 and wherein said human comprises a Vκ gene segment encoding aCDR3 comprising a Pro at position 7 shown in SEQ ID NO: 113, or thehuman expresses Vκ domains that comprise a CDR3 comprising a Pro atposition 7 shown in SEQ ID NO: 113; or (ii) a FW3 comprising a Ser atposition 15 shown in SEQ ID NO: 115 and wherein said human comprises aVκ gene segment encoding a FW3 comprising a Ser at position 15 shown inSEQ ID NO: 115 or the human expresses Vκ domains that comprise a FW3comprising a Ser at position 15 shown in SEQ ID NO: 115.(iv) wherein the ligand comprises a human gamma-1 heavy chain constantregion that comprises an Asp at position 204 shown in SEQ ID NO: 81 or aLeu at position 206 shown in SEQ ID NO: 81 and wherein said humancomprises (i) an IGHG1*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-1heavy chain constant regions comprising an Asp at position 204 shown inSEQ ID NO: 81 or a Leu at position 206 shown in SEQ ID NO: 81.(v) wherein the ligand comprises a human gamma-2 heavy chain constantregion that comprises an amino acid selected from the group consistingof a Pro at position 72 shown in SEQ ID NO: 83, an Asn at position 75shown in SEQ ID NO: 83, a Phe at position 76 shown in SEQ ID NO: 83, aVal at position 161 shown in SEQ ID NO: 83 and an Ala at position 257shown in SEQ ID NO: 83 and wherein said human comprises (i) an IGHG2*01human heavy chain constant region gene segment, or the human expressesantibodies comprising human gamma-2 heavy chain constant regionscomprising said selected Pro at position 72 shown in SEQ ID NO: 83, Asnat position 75 shown in SEQ ID NO: 83, Phe at position 76 shown in SEQID NO: 83, Val at position 161 shown in SEQ ID NO: 83 or Ala at position257 shown in SEQ ID NO: 83.(vi) wherein the ligand comprises a human kappa chain constant regionthat comprises a Val at position 84 shown in SEQ ID NO: 93 or a Cys atposition 87 shown in SEQ ID NO: 93 and wherein said human comprises (i)an IGKC1*01 human kappa chain constant region gene segment, or the humanexpresses antibodies comprising human kappa chain constant regionscomprising a Val corresponding to position 84 shown in SEQ ID NO: 93 ora Cys at position 87 shown in SEQ ID NO: 93.(vii) wherein the ligand comprises a human IGLC1*01 lambda chainconstant region and wherein said human comprises (i) a human IGLC1*01lambda chain constant region gene segment, or the human expressesantibodies comprising human IGLC1*01 lambda chain constant regions.

For example, as per example (iv), the inventor identified thepossibility of addressing the rarer IGH-gamma-1 SNPs 204D (observedcumulative frequency of 0.296) and 206L (observed cumulative frequencyof 0.283) individually or in combination. These residues are part of theCH3 domain, and as such they form part of antibody Fc regions. Thus,matching of these CH3 variations with the patient is especiallybeneficial for reasons as discussed above. Thus, in this example theligand of the invention comprises or consists of an antibody thatcomprises a human gamma-1 heavy chain constant region that comprises anAsp corresponding to position 204 of SEQ ID NO: 81 or a Leucorresponding to position 206 of SEQ ID NO: 81 and wherein the genome ofthe human comprises a gamma-1 heavy chain constant region nucleotidesequence that encodes such an Asp or Leu or the human expressesantibodies comprising human gamma-1 constant regions comprising such anAsp or Leu. An example of such a ligand is sarilumab.

In another example, as per example (v), the inventor identified thepossibility of addressing IGH-gamma-2 SNPs. This included considerationof Fc region variation—in this respect, the inventor focused onpositions 161 and 257 which are in the Fc region. Thus, in this examplethe ligand of the invention comprises or consists of an antibody thatcomprises a human gamma-2 heavy chain constant region that comprises anamino acid selected from the group consisting of a Pro corresponding toposition 72 of SEQ ID NO: 83, an Asn corresponding to position 75 of SEQID NO: 83, a Phe corresponding to position 76 of SEQ ID NO: 83, a Valcorresponding to position 161 of SEQ ID NO: 83 and an Ala correspondingto position 257 of SEQ ID NO: 83; and wherein the genome of the humancomprises a gamma-2 heavy chain constant region nucleotide sequence thatencodes such a selected amino acid or the human expresses antibodiescomprising human gamma-2 constant regions comprising such a selectedamino acid.

In another example, as per example (vi), the inventor addressed humankappa constant region variation. Thus, in this example the ligand of theinvention comprises or consists of an antibody that comprises a humankappa light chain constant region that comprises a Val corresponding toposition 84 of SEQ ID NO: 93 or a Cys corresponding to position 87 ofSEQ ID NO: 93; and wherein the genome of the human comprises a kappalight chain constant region nucleotide sequence that encodes such a Valor Cys or the human expresses antibodies comprising human kappa lightchain constant regions comprising such a Val or Cys. An example of sucha ligand is sarilumab.

In another example, as per example (vii), the inventor addressed humanlambda constant region variation. Thus, in this example the ligand ofthe invention comprises or consists of an antibody that comprises ahuman IGLC2*01 light chain constant region; and wherein the genome ofthe human comprises a human IGLC2*01 nucleotide sequence or the humanexpresses antibodies comprising human light chain IGLC2*01 constantregions.

Determination of Specific Binding of Ligands of the Invention to IL6RVariants

The specific binding of ligands of the invention to IL6R variants can beperformed using the following method.

Method of SPR Determination of Binding

Binding of the antibodies to the IL6R variants is carried out by SPRusing the ProteOn XPR36™ Array system (BioRad). An anti-human IgGsurface (Jackson Labs 109-005-008) was created on a GLC Biosensor chipby primary amine coupling. Test antibodies are captured on this surfaceas ligands. The IL6R variants are used as analytes and passed over thecaptured antibodies at 256 nM, 64 nM, 16 nM, 4 nM and 1 nM. Bindingcurves are double referenced using a buffer injection (i.e. 0 nM) toremove baseline drift and injection artefacts. Regeneration of thecapture surface is with 100 mM phosphoric acid which removes thecaptured antibody allowing another cycle of capture and binding. Thebinding sensorgrams generated are analysed using the 1:1 model inherentto the ProteOn XPR36 Array system analysis software. The assay isperformed at 25° C. and using 1xHBS-EP (Teknova) as running buffer.

REFERENCES

The references cited herein are incorporated by reference in theirentirety

-   1. Ferreira et al (PLoS Genet. 2013 April; 9(4):e1003444. doi:    10.1371/journal.pgen.1003444. Epub 2013 Apr. 4, “Functional    IL6R358Ala allele impairs classical IL-6 receptor signaling [sic]    and influences risk of diverse in flammatory diseases”; Rantala A et    al, Hum Immunol. 2011 January; 72(1):63-8. doi:    10.1016/j.humimm.2010.10.010. Epub 2010 Oct. 15, “Association of    IL-6 and IL-6R gene polymorphisms with susceptibility to respiratory    tract infections in young Finnish men”;-   2. Zhang H Y et al, Oral Dis. 2014 January; 20(1):69-75. doi:    10.1111/odi.12075. Epub 2013 Feb. 24, “The association of IL-6 and    IL-6R gene polymorphisms with chronic periodontitis in a Chinese    population”;-   3. J C Galicia et al, Genes and Immunity (2004) 5, 513-516.    doi:10.1038/sj.gene.6364120 Published online 12 Aug. 2004,    “Polymorphisms in the IL-6 receptor (IL-6R) gene: strong evidence    that serum levels of soluble IL-6R are genetically influenced”;-   4. Esparza-Gordillo J et al, J Allergy Clin Immunol 2013 August;    132(2):371-7. doi: 10.1016/j.jaci.2013.01.057. Epub 2013 Apr. 9, “A    functional IL-6 receptor (IL6R) variant is a risk factor for    persistent atopic dermatitis”.

TABLE 14 1000 GENOMES PROJECT HUMAN POPULATIONS Below is a summary ofthe ethnic populations as per the 1000 Genomes Project sequences. (a)100 Genome Populations Super Population Population Code PopulationDescription Code CHB Han Chinese in Bejing, China ASN JPT Japanese inTokyo, Japan ASN CHS Southern Han Chinese ASN CDX Chinese Dai inXishuangbanna, China ASN KHV Kinh in Ho Chi Minh City, Vietnam ASN CEUUtah Residents (CEPH) with Northern and EUR Western European ancestryTSI Toscani in Italia EUR FIN Finnish in Finland EUR GBR British inEngland and Scotland EUR IBS Iberian population in Spain EUR YRI Yorubain Ibadan, Nigera AFR LWK Luhya in Webuye, Kenya AFR GWD Gambian inWestern Divisons in The Gambia AFR MSL Mende in Sierra Leone AFR ESNEsan in Nigera AFR ASW Americans of African Ancestry in SW USA AFR ACBAfrican Carribbeans in Barbados AFR MXL Mexican Ancestry from LosAngeles USA AMR PUR Puerto Ricans from Puerto Rico AMR CLM Colombiansfrom Medellin, Colombia AMR PEL Peruvians from Lima, Peru AMR GIHGujarati Indian from Houston, Texas SAN PJL Punjabi from Lahore,Pakistan SAN BEB Bengali from Bangladesh SAN STU Sri Lankan Tamil fromthe UK SAN ITU Indian Telugu from the UK SAN (b) Super Populations AFR,African AMR, Ad Mixed American ASN, East Asian EUR, European SAN, SouthAsian (c) Population Ancestries European ancestry Utah residents (CEPH)with Northern and Western European ancestry (CEU) Toscani in Italia(TSI) British from England and Scotland (GBR) Finnish from Finland (FIN)Iberian populations in Spain (IBS) East Asian ancestry Han Chinese inBeijing, China (CHB) Japanese in Toyko, Japan (JPT) Han Chinese South(CHS) Chinese Dai in Xishuangbanna (CDX) Kinh in Ho Chi Minh City,Vietnam (KHV) Chinese in Denver, Colorado (CHD) (pilot 3 only) WestAfrican ancestry Yoruba in Ibadan, Nigeria (YRI) Luhya in Webuye, Kenya(LWK) Gambian in Western Division, The Gambia (GWD) Malawian inBlantyre, Malawi (MAB) West African Population (TBD) Americas AfricanAncestry in Southwest US (ASW) African American in Jackson, MS (AJM)African Caribbean in Barbados (ACB) Mexican Ancestry in Los Angeles, CA(MXL) Puerto Rican in Puerto Rico (PUR) Colombian in Medellin, Colombia(CLM) Peruvian in Lima, Peru (PEL) South Asian ancestry Ahom in theState of Assam, India Kayadtha in Calcutta, India Reddy in Hyderabad,India Maratha in Bombay, India Punjabi in Lahore, Pakistan

TABLE 15 Exemplary anti-IL6R disclosures, eg of antibodies and/orantibody fragments, assays, treatments, formulations, kits, methods andindications, useful in any and all aspects of the invention Patent orpatent application which is incorporated by reference in its entirety,and specifically, eg, with respect to the SEQ ID Nos. comprising ananti-IL6R monoclonal antibody or fragment thereof U.S. Pat. No.8,568,721, US20130157313A1, US20130149310A1, US20130122003A1, U.S. Pat.No. 8,192,741, U.S. Pat. No. 8,183,014, US20120003697A1, U.S. Pat. No.8,080,248, U.S. Pat. No. 8,043,617, US20110171241A1, US20100316636A1,US20100316627A1, U.S. Pat. No. 7,582,298

TABLE 16 Human antibody gene segment variants distributed over severalhuman ethnic populations - useful for ligand tailoring ExampleNucleotide Hom Human Amino Acid Variaton³ Freq⁸ Gene Example Coordinate²(NCB dbSNP Variant (Het + Segment Human & reference Nucleotide Human No.Het Hom Cum Type Allele¹ Variation number)⁴ Position Populations⁵Individs⁶ Freq⁷ freq⁹) Freq¹⁰ IGHV3-9 IGHV3-9*01 30F TTT (IMGTnumbering) (Phe at position 4 in SEQ ID NO: 32) (CDR1 variation)IGHV3-9*02 30S TCT (IMGT numbering) (CDR1 variation) IGHV3-9*01 110T ACG14:106552310 B 1015 0.082 0.847 0.888 (Thr at position 33 in (forwardstrand) (0.929) SEQ ID NO: 34) (FW3 variation) IGHV3-9*03 110M ATG14:106552310 B 167 0.082 0.071 0.112 (FW3 variation) (rs8020204)(forward strand) (0.153) IGKV3-11 IGKV3-11*01 115P CCT 2:89326669 B 10900.064 0.934 0.966 (Pro at position 7 in (forward strand) (0.998) SEQ IDNO: 36) (CDR3 variation) 115H CAT 2:89326669 B 72 0.064 0.002 0.034(CDR3 variation) (rs182958807) (forward strand) (0.066) IGKV3-11*01 87STCT 2:89326754 B 1090 0.074 0.924 0.961 (Ser at position 15 in (forwardstrand) (0.998) SEQ ID NO: 38) (FW3 variation) 87P CCT 2:89326754 B 830.074 0.002 0.039 (FW3 variation) (rs191612627) (forward strand) (0.076)IGKC IGKC*01 84V GTC 2:89156948 B 454 0.345 0.071 0.243 (Val at position84 in (forward strand) (0.416) SEQ ID NO: 16) IGKC*04 84L CTC 2:89156948B 1015 0.345 0.584 0.757 (rs232230) (forward strand) (0.929) IGKC*01 87CTGC 2:89156939 (Cys at position 87 in (forward strand) SEQ ID NO: 16)IGKC*02 87G GGC 2:89156939 (rs200765148) (forward strand) IGHG1 IGHG1*01204D GAT 14:106208086 A 153 0.400 0.096 0.296 (CH3 variation) (forwardstrand) (European (0.496) ancestry) IGHG1*03 204E GAG 14:106208086 A 3660.400 0.504 0.704 (CH3 variation) (rs1045853) (forward strand) (European(0.904) ancestry IGHG1*01 206L CTG 14:106208082 A 0.358 0.104 0.283 (CH3variation) (forward strand) (European (0.462) ancestry) IGHG1*03 206MATG 14:106208082 A 0.358 0.538 0.717 (CH3 variation) (rs11621259)(forward strand) (European (0.896) ancestry) IGHG2 IGHG2*01 72P CCC14:106110914 B 0.336 0.540 0.708 (CH1 variation) (forward strand)(0.876) IGHG2*02 72T ACC 14:106110914 B 0.336 0.124 0.292 (CH1variation) (rs11627594) (forward strand) IGHG2*01 75N AAC 14:106110904 A0.007 0.993 0.997 (CH1 variation) (forward strand) IGHG2*04 75S AGC14:106110904 A 0.007 0.004 (CH1 variation) (rs201590297) (forwardstrand) IGHG2*01 76F TTC (CH1 variation) IGHG2*04 76L TTG (CH1variation) IGHG2*01 161V GTG 14:10611013 B 0.342 0.539 0.711 (CH2variation) (forward strand) (0.881) IGHG2*02 161M ATG 14:10611013 B0.342 0.118 0.289 (CH2 variation) (rs8009156) (forward strand) (0.46)IGHG2*01 257A GCC 14:106109752 C 0.199 0.493 0.592 (CH3 variation)(forward strand) (0.692) D 0.007 0.992 0.995 (0.999) IGHG2*06 257S TCC14:106109752 C 0.199 0.308 0.408 (CH3 variation) (rs4983499) (forwardstrand) (0.507) D 0.007 0.002 0.005 (0.009) Table Footnotes: ¹⁰IMGTnotation (ww.imgt.org); refer to figures for other alleles comprisingthis variation. ¹¹Numbering as indicated in Ensembl (available on theWorld Wide Web at ensembl.org) unless otherwise indicated ¹²SNPUnderlined in Codon. ¹³NCBI dbSNP Build 138 released on Apr. 25, 2013.¹⁴Human population used for representative variant frequency analysis.Populations A This population included 662 participants of Europeandescent from the ClinSeq project, all of whom had undergone whole-exomesequencing using Agilent's 38Mb or 50Mb capture kit. B 1000 Genomesdatabase. C ESP6500:African_American. D ESP6500:European_American.¹⁵Number of individuals in representative population found to have theallele. ¹⁶Heterozygous human genotype frequency, ie, cumulativefrequency of all genotypes having one occurrence of the variant alleleand one occurrence of another allele (heterozygous state), eg, acgenotype in the population. ¹⁷Homozygous human genotype frequency, ie,cumulative frequency of two occurrences of the variant allele(homozygous state), eg, cc genotype in the population. ¹⁸Total humangenotype frequency, ie, total of heterozygous plus homozygous humangenotype frequencies. ¹⁹Cumulative human allele frequency of alloccurrences of the variant allele in the population.

TABLE 17 SEQUENCES SEQ ID NO: Human AlleleNucleotide/Amino Acid Sequence  78 IL-6RMLAVGCALLAALLAAPGAALAPRRCPAQEVARGVLTSLPGDSVTLTCPGVEPEDNATVHWVLRKPAAGSHPSRWAGMGRRLLLRSVQLHDSGNYSCYRAGRPAGTVHLLVDVPPEEPQLSCFRKSPLSNVVCEWGPRSTPSLTTKAVLLVRKFQNSPAEDFQEPCQYSQESQKFSCQLAVPEGDSSFYIVSMCVASSVGSKFSKTQTFQGCGILQPDPPANITVTAVARNPRWLSVTWQDPHSWNSSFYRLRFELRYRAERSKTFTTWMVKDLQHHCVIHDAWSGLRHVVQLRAQEEFGQGEWSEWSPEAMGTPWTESRSPPAENEVSTPMQALTTNKDDDNILFRDSANATSLPVQ D SSSVPLPTFLVAGGSLAFGT LLCIAI VLRFKKTWKLRALKEGKTSMHPPYSLGQLVPERPRPTPVLVPLISPPVSPSSLGSDNTSSHNRPDARDPRSPYDISNTDYFFPR D  = position 358 V  = position 385 79 ATGCTGGCCGTCGGCTGCGCGCTGCTGGCTGCCCTGCTGGCCGCGCCGGGAGCGGCGCTGGCCCCAAGGC GCTGCCCTGCGCAGGAGGTGGCGAGAGGCGTGCTGACCAGTCTGCCAGGAGACAGCGTGACTCTGACCTG CCCGGGGGTAGAGCCGGAAGACAATGCCACTGTTCACTGGGTGCTCAGGAAGCCGGCTGCAGGCTCCCAC CCCAGCAGATGGGCTGGCATGGGAAGGAGGCTGCTGCTGAGGTCGGTGCAGCTCCACGACTCTGGAAACT ATTCATGCTACCGGGCCGGCCGCCCAGCTGGGACTGTGCACTTGCTGGTGGATGTTCCCCCCGAGGAGCC CCAGCTCTCCTGCTTCCGGAAGAGCCCCCTCAGCAATGTTGTTTGTGAGTGGGGTCCTCGGAGCACCCCA TCCCTGACGACAAAGGCTGTGCTCTTGGTGAGGAAGTTTCAGAACAGTCCGGCCGAAGACTTCCAGGAGC CGTGCCAGTATTCCCAGGAGTCCCAGAAGTTCTCCTGCCAGTTAGCAGTCCCGGAGGGAGACAGCTCTTT CTACATAGTGTCCATGTGCGTCGCCAGTAGTGTCGGGAGCAAGTTCAGCAAAACTCAAACCTTTCAGGGT TGTGGAATCTTGCAGCCTGATCCGCCTGCCAACATCACAGTCACTGCCGTGGCCAGAAACCCCCGCTGGC TCAGTGTCACCTGGCAAGACCCCCACTCCTGGAACTCATCTTTCTACAGACTACGGTTTGAGCTCAGATA TCGGGCTGAACGGTCAAAGACATTCACAACATGGATGGTCAAGGACCTCCAGCATCACTGTGTCATCCAC GACGCCTGGAGCGGCCTGAGGCACGTGGTGCAGCTTCGTGCCCAGGAGGAGTTCGGGCAAGGCGAGTGGA GCGAGTGGAGCCCGGAGGCCATGGGCACGCCTTGGACAGAATCCAGGAGTCCTCCAGCTGAGAACGAGGT GTCCACCCCCATGCAGGCACTTACTACTAATAAAGACGATGATAATATTCTCTTCAGAGATTCTGCAAAT GCGACAAGCCTCCCAGTGCAAGATTCTTCTTCAGTACCACTGCCCACATTCCTGGTTGCTGGAGGGAGCC TGGCCTTCGGAACGCTCCTCTGCATTGCCATTGTTCTGAGGTTCAAGAAGACGTGGAAGCTGCGGGCTCT GAAGGAAGGCAAGACAAGCATGCATCCGCCGTACTCTTTGGGGCAGCTGGTCCCGGAGAGGCCTCGACCC ACCCCAGTGCTTGTTCCTCTCATCTCCCCACCGGTGTCCCCCAGCAGCCTGGGGTCTGACAATACCTCGA GCCACAACCGACCAGATGCCAGGGACCCACGGAGCCCTTATGACATCAGCAATACAGACTACTTCTTCCC CAGATAG HEAVY CHAIN ALLELES  80 IGHG1*01gcctccaccaagggcccatcggtcttccccctggcaccctcctccaagagcacctctggg (CH1 +Hinge + ggcacagcggccctgggctgcctggtcaaggactacttccccgaaccggtgacggtgtcgCH2 + CH3 + tggaactcaggcgccctgaccagcggcgtgcacaccttcccggctgtcctacagtcctcaCH − S) ggactctactccctcagcagcgtggtgaccgtgccctccagcagcttgggcacccagacctacatctgcaacgtgaatcacaagcccagcaacaccaaggtggacaagaaagttgagcccaaatcttgtgacaaaactcacacatgcccaccgtgcccagcacctgaactcctggggggaccgtcagtcttcctcttccccccaaaacccaaggacaccctcatgatctcccggacccctgaggtcacatgcgtggtggtggacgtgagccacgaagaccctgaggtcaagttcaactggtacgtggacggcgtggaggtgcataatgccaagacaaagccgcgggaggagcagtacaacagcacgtaccgggtggtcagcgtcctcaccgtcctgcaccaggactggctgaatggcaaggagtacaagtgcaaggtctccaacaaagccctcccagcccccatcgagaaaaccatctccaaagccaaagggcagccccgagaaccacaggtgtacaccctgcccccatcccgggatgagctgaccaagaaccaggtcagcctgacctgcctggtcaaaggcttctatcccagcgacatcgccgtggagtgggagagcaatgggcagccggagaacaactacaagaccacgcctcccgtgctggactccgacggctccttcttcctctacagcaagctcaccgtggacaagagcaggtggcagcaggggaacgtcttctcatgctccgtgatgcatgaggctctgcacaaccactacacgcagaagagcctctccctgtctccgggtaaa  81ASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSR D E LTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK D  = position 204 L  = position 206  82IGHG2*01 gcctccaccaagggcccatcggtcttccccctggcgccctgctccaggagcacctccgag(CH1 + Hinge +agcacagccgccctgggctgcctggtcaaggactacttccccgaaccggtgacggtgtcg CH2 + CH3 +tggaactcaggcgctctgaccagcggcgtgcacaccttcccagctgtcctacagtcctca CH − S)ggactctactccctcagcagcgtggtgaccgtgccctccagcaacttcggcacccagacctacacctgcaacgtagatcacaagcccagcaacaccaaggtggacaagacagttgagcgcaaatgttgtgtcgagtgcccaccgtgcccagcaccacctgtggcaggaccgtcagtcttcctcttccccccaaaacccaaggacaccctcatgatctcccggacccctgaggtcacgtgcgtggtggtggacgtgagccacgaagaccccgaggtccagttcaactggtacgtggacggcgtggaggtgcataatgccaagacaaagccacgggaggagcagttcaacagcacgttccgtgtggtcagcgtcctcaccgttgtgcaccaggactggctgaacggcaaggagtacaagtgcaaggtctccaacaaaggcctcccagcccccatcgagaaaaccatctccaaaaccaaagggcagccccgagaaccacaggtgtacaccctgcccccatcccgggaggagatgaccaagaaccaggtcagcctgacctgcctggtcaaaggcttctaccccagcgacatcgccgtggagtgggagagcaatgggcagccggagaacaactacaagaccacacctcccatgctggactccgacggctccttcttcctctacagcaagctcaccgtggacaagagcaggtggcagcaggggaacgtcttctcatgctccgtgatgcatgaggctctgcacaaccactacacgcagaagagcctctccctgtctccgggtaaa  83ASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSS GLYSLSSVVTVP SS NF GTQTYTCNVDHKPSNTKVDKTVERKCCVECPPCPAPPVAGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVQFNWYVDG V EVHNAKTKPREEQFNSTFRVVSVLTVVHQDWLNGKEYKCKVSNKGLPAPIEKTISKTKGQPREPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDI A VEWESNGQPENNYKTTPPMLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK P  = position 72 N  = position 75 F  =position 76 V  = position 161 A  = position 257  84 IGHV3-9*01gaagtgcagctggtggagtctgggggaggcttggtacagcctggcaggtccctgagactctcctgtgcagcctctggattcacct t tgatgattatgccatgcactgggtccggcaagctccagggaagggcctggagtgggtctcaggtattagttggaatagtggtagcataggctatgcggactctgtgaagggccgattcaccatctccagagacaacgccaagaactccctgtatctgcaaatgaacagtctgagagctgaggac a cggccttgtattactgtgcaaaagata t  = nucleotide number 86 c  =nucleotide number 272  85 EVQLVESGGGLVQPGRSLRLSCAASGFT FDDYAMHWVRQAPGKGLEWVSGISWN SGSIGYADSVKGRFTISRDNAKNSLYLQMNSLRAED TALYYCAKD F  = position 30 (IMGT nomenclature) T  =position 110 (dbSNP nomenclature)  86 IGHV3-7*01gaggtgcagctggtggagtctgggggaggcttggtccagcctggggggtccctg agactctcctgtgcagcctctggattcacctttagtagctattggatgagctgggtccgc caggctccagggaaggggctggagtgggtggccaacataaagcaagatggaagtgagaaa tactatgtggactctgtgaagggccgattcaccatctccagagacaacgccaagaactca ctgtatctgcaaatgaacagcctgagagccgaggacacggctgtgtattactgtgcgaga ga  87EVQLVESGGGLVQPGGSLRLSCAASGFTFSSYWMSWVRQAPGKGLEWVANIKQDGSEKYYVDSVKGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCAR  88 IGHJ3*02T GAT GCT TTT GAT ATC TGG GGC CAA GGG ACA ATG GTC ACC GTC TCT TCA G  89D   A   F   D   I   W   G   Q   G   T   M   V   T   V   S S  90 IGHJ6*01AT TAC TAC TAC TAC TAC GGT ATG GAC GTC TGG GGG CAA GGGACC ACG GTC ACC GTC TCC TCA G  91Y   Y   Y   Y   Y   G   M   D   V   W   G   Q   G   TT   V   T   V   S   S LIGHT CHAIN ALLELES  92 IGKC*01cgaactgtggctgcaccatctgtcttcatcttcccgccatctgatgagcagttgaaatctggaactgcctctgttgtgtgcctgctgaataacttctatcccagagaggccaaagtacagtggaaggtggataacgccctccaatcgggtaactcccaggagagtgtcacagagcaggacagcaaggacagcacctacagcctcagcagcaccctgacgctgagcaaagcagactacgagaaacacaaagtctacgcctgcgaagtcacccatcagggcctgagctcgcccgtcacaaagagcttcaacaggggagagtgt  93RTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHK V YA C EVTHQGLSSPVTKSFNRGEC V  = position 84 C = position 87  94 IGLC1*01cccaaggccaaccccacggtcactctgttcccgccctcctctgaggagctccaagccaacaaggccacactagtgtgtctgatcagtgacttctacccgggagctgtgacagtggcttggaaggcagatggcagccccgtcaaggcgggagtggagacgaccaaaccctccaaacagagcaacaacaagtacgcggccagcagctacctgagcctgacgcccgagcagtggaagtcccacagaagctacagctgccaggtcacgcatgaagggagcaccgtggagaagacagtggcccctacagaatgttca  95 PKANPTVTLFPPSSEELQANKATLVCLISDFYPGAVTVAWKADGSPVKAGVETTKPSKQSNNKYAASSYLSLTPEQWKSHRSYSCQVTHEGSTVEKTVAPTECS  96 IGKV1-12*01gacatccagatgacccagtctccatcttccgtgtctgcatctgtaggagacagagtcaccatcacttgtcgggcgagtcagggtattagcagctggttagcctggtatcagcagaaaccagggaaagcccctaagctcctgatctatgctgcatccagtttgcaaagtggggtcccatcaaggttcagcggcagtggatctgggacagatttcactctcaccatcagcagcctgcagcctgaagattttgcaacttactattgtcaacaggctaacagtttccctcc  97DIQMTQSPSSVSASVGDRVTITCRASQGISSWLAWYQQKPGKAPKLLIYAASSLQSGVPSRFSGSGSGTDFTLTISSLQPEDFATYYCQQANSFP  98 IGKV3-11*01gaaattgtgttgacacagtctccagccaccctgtctttgtctccaggggaaagagccaccctctcctgcagggccagtcagagtgttagcagctacttagcctggtaccaacagaaacctggccaggctcccaggctcctcatctatgatgcatccaacagggccactggcatcccagccaggttcagtggcagtggg t ctgggacagacttcactctcaccatcagcagcctagagcctgaagattttgcagtttattactgtcagcagcgtagcaactggc c tcc t  =nucleotide number 199 c  = nucleotide number 284  99EIVLTQSPATLSLSPGERATLSCRASQSVSSYLAWYQQKPGQAPRLLIYDASNRATGIPA RFSGSG SGTDFTLTISSLEPEDFAVYYCQQRSNW P S  = position 87 P  = position 115 100IGKJ2*01 tgtacacttttggccaggggaccaagctggagatcaaac 101 YTFGQGTKLEIK 102IGKJ4*01 G CTC ACT TTC GGC GGA GGG ACC AAG GTG GAG ATC AAA C 103L   T   F   G   G   G   T   K   V   E   I   K 104 An IGHG1*01EVQLVESGGG LVQPGRSLRL SCAASRFTFD DYAMHWVRQA PGKGLEWVSG Heavy ChainISWNSGRIGY ADSVKGRFTI SRDNAENSLF LQMNGLRAED TALYYCAKGR DSFDIWGQGTMVTVSSASTK GPSVFPLAPS SKSTSGGTAA LGCLVKDYFP EPVTVSWNSG ALTSGVHTFPAVLQSSGLYS LSSVVTVPSS SLGTQTYICN VNHKPSNTKV DKKVEPKSCD KTHTCPPCPAPELLGGPSVF LFPPKPKDTL MISRTPEVTC VVVDVSHEDP EVKFNWYVDG VEVHNAKTKPREEQYNSTYR VVSVLTVLHQ DWLNGKEYKC KVSNKALPAP IEKTISKAKG QPREPQVTYLPPSRDELTKN QVSLTCLVKG FYPSDIAVEW ESNGQPENNY KTTPPVLDSD GSFFLYSKLTVDKSRWQQGN VFSCSVMHEA LHNHYTQKSL SLSPGK 105 An IGKC*01DIQMTQSPSS VSASVGDRVT ITCRASQGIS SWLAWYQQKP GKAPKLLIYG Kappa LightASSLESGVPS Chain RFSGSGSGTD FTLTISSLQP EDFASYYCQQ ANSFPYTFGQ GTKLEIKRTVAAPSVFIFPP SDEQLKSGTA SVVCLLNNFY PREAKVQWKV DNALQSGNSQ ESVTEQDSKDSTYSLSSTLT LSKADYEKHK VYACEVTHQG LSSPVTKSFN RGEC 106 An IGHG1*01EVQLVESGGGLVQPGGSLRLSCAASGFTFSPFAMSWVRQAPGKGLEWVAKISPG Heavy ChainGSWTYY SDTVTGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCARQLWGYYALDIWGQGTT VTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPA VLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKVEPKSCDKTHTCPPCPAP ELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPR EEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLP PSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQ QGNVFSCSVMHEALHNHYTQKSLSLSPGK 107 An IGKC*01EIVLTQSPATLSLSPGERATLSCSASISVSYMYWYQQKPGQAPRLLIYDMSNLA Kappa LightSGIPAR Chain FSGSGSGTDFTLTISSLEPEDFAVYYCMQWSGYPYTFGGGTKVEIKRTVAAPSVFIFPPS DEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTL SKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC 108 IGHV3-9*01 ggattcacct ttgatgattatgcc CDR1 (IMGT t  = position 11 nomenclature) 109 G  F  T   F  D  D  Y  A F  = position 4 110 IGHV3-9*01ggc tat gcg gac tct gtg aag ggc cga ttc acc atc tcc FW3 (IMGTaga gac aac gcc aag aac tcc ctg tat ctg caa atg aac nomenclature)agt ctg aga gct gag gac a c g gcc ttg tat tac tgt c  = position 98 111G  Y  A  D  S  V  K  G  R  F  T  I  S  RD  N  A  K  N  S  L Y  L  Q  M  N  S  L R  A  E  D   T   A L Y  Y  C T = position 33 112 IGKV3-11*01 CAG CAG CGT AGC AAC TGG C C T CCCDR3 (IMGT C  = nucleotide 20 Nomenclature) 113 QQRSNW P P  = position 7114 IGKV3-11*01 aacagggccactggcatcccagccaggttcagtggcagtggg tctgggacagacttcact FW3 (IMGTctcaccatcagcagcctagagcctgaagattttgcagtttattactgt Nomenclature) T  =nucleotide 43 115 NRATGIPARFSGSG S GTDFTLTISSLEPEDFAVYYC S  =position 15 127 AfliberceptSDTGRPFVEMYSEIPEIIHMTEGRELVIPCRVTSPNITVTLKKFPLDTLIPDGKRIIWDS polypeptideRKGFIISNATYKEIGLLTCEATVNGHLYKTNYLTHRQTNTII

sequence

FVRVHEKDKTHTCPPCP A PELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKA K

 QPREPQVYTLPPSR D E L TKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPG (SEQ ID NO: 127) DKTHTCPPCP (SEQ ID NO: 128) =C-terminal part of IGHG1*01 hinge A  =start of human IGHG1*01 CH2 sequence K  =end of human IGHG1*01 CH2 sequence

 = start of human IGHG1*01 CH3 sequence D  =Asp 204(corresponding to position 204 in SEQ ID NO: 42) L  =Leu 206(corresponding to position 206 in SEQ ID NO: 42)Fltl Ig-like C2-type 2 domainGRELVIPCRVTSPNITVTLKKFPLDTLIPDGKRIIWDSRKGFIISNATYKEIGLLTCEATVNGH (SEQ ID NO: 129) KDR Ig-like C2-type 3 domain

+Z,325 

 (SEQ ID NO: 130) 129 Flt1 Ig-likeGRELVIPCRVTSPNITVTLKKFPLDTLIPDGKRIIWDSRKGFIISNATYKEIGLLTCEAT C2-type 2VNGH domain 130 KDR Ig-likeYDVVLSPSHGIELSVGEKLVLNCTARTELNVGIDFNWEYPSSKHQHKKLVNRDLKTQSGS C2-type 3EMKKFLSTLTIDGVTRSDQGLYTCAASSGLMTKKNST domain 131 A human VEGFAMNFLLSWVHWSLALLLYLHHAKWSQAAPMAEGGGQNHHEVVKFMDVYQRSYCHPIETLVD sequenceIFQEYPDEIEYIFKPSCVPLMRCGGCCNDEGLECVPTEESNITMQIMRIKPHQGQHIGEM(isoform 206)SFLQHNKCECRPKKDRARQEKKSVRGKGKGQKRKRKKSRYKSWSVYVGARCCLMPWSLPGPHPCGPCSERRKHLFVQDPQTCKCSCKNTDSRCKARQLELNERTCRCDKPRR 132 A human VEGFAMNFLLSWVHWSLALLLYLHHAKWSQAAPMAEGGGQNHHEVVKFMDVYQRSYCHPIETLVD sequenceIFQEYPDEIEYIFKPSCVPLMRCGGCCNDEGLECVPTEESNITMQIMRIKPHQGQHIGEM(isoform 165)SFLQHNKCECRPKKDRARQENPCGPCSERRKHLFVQDPQTCKCSCKNTDSRCKARQLELN ERTCRCDKPRR133 A human PD-L1 MRIFAVFIFMTYWHLLNAFTVTVPKDLYVVEYGSNMTIECKFPVEKQLDLAALIsequence VYWEME (ENST000003815DKNIIQFVHGEEDLKVQHSSYRQRARLLKDQLSLGNAALQITDVKLQDAGVYRC 77) MISYGGADYKRITVKVNAPYNKINQRILVVDPVTSEHELTCQAEGYPKAEVIWTSSDHQV LSGKTTTTNSKREEKLFNVTSTLRINTTTNEIFYCTFRRLDPEENHTAELVIPELPLAHP PNERTHLVILGAILLCLGVALTFIFRLRKGRMMDVKKCGIQDTNSKKQSDTHLEET

Example 5 VEGF-A, PDGF-B PATHWAY & ANG-2

VEGF-A is also referred to as VEGF, Vascular Endothelial Growth FactorA, MVCD1, VEGF-A, Vascular Endothelial Growth Factor, VascularPermeability Factor and VPF. Human VEGF-A binds to the human FLT1/VEGFR1and KDR/VEGFR2 receptors. Human isoforms, including VEGF-165 andVEGF-145, have been observed.

Vascular endothelial growth factor (VEGF) is a highly specific mitogenfor vascular endothelial cells. Five VEGF isoforms are generated as aresult of alternative splicing from a single VEGF gene. These isoformsdiffer in their molecular mass and in biological properties such astheir ability to bind to cell-surface heparan-sulfate proteoglycans. Theexpression of VEGF is potentiated in response to hypoxia, by activatedoncogenes, and by a variety of cytokines. VEGF induces endothelial cellproliferation, promotes cell migration, and inhibits apoptosis. In vivoVEGF induces angiogenesis as well as permeabilization of blood vessels,and plays a central role in the regulation of vasculogenesis.Deregulated VEGF expression contributes to the development of solidtumours by promoting tumour angiogenesis and to the etiology of severaladditional diseases that are characterized by abnormal angiogenesis.Consequently, inhibition of VEGF signalling abrogates the development ofa wide variety of tumours. The various VEGF forms bind to twotyrosine-kinase receptors, VEGFR-1 (flt-1) and VEGFR-2 (KDR/flk-1) inhumans, which are expressed almost exclusively in endothelial cells.Endothelial cells express in addition the neuropilin-1 and neuropilin-2coreceptors, which bind selectively to the 165 amino acid form of VEGF(VEGF165).

VEGF is a key regulator of angiogenesis, and its expression in producingcells is regulated by a plethora of external factors. Cytokines, growthfactors, and gonadotropins that do not stimulate angiogenesis directlycan modulate angiogenesis by modulating VEGF expression in specific celltypes, and thus exert an indirect angiogenic or anti-angiogenic effect.Factors that can potentiate VEGF production include fibroblast growthfactor 4 (FGF-4), PDGF, tumour necrosis factor α, transforming growthfactor β (TGF-β), keratinocyte growth factor (KGF), IGF-I, interleukin1β (IL-1β), and IL-6.

Angiogenesis has a causal role in many diseases, including neovascularage-related macular degeneration (AMD). Identification of key regulatorsof angiogenesis, including vascular endothelial growth factor (VEGF),fibroblast growth factor 2, pigment epithelium-derived growth factor,angiopoietins and extracellular matrix molecules, has facilitated thedevelopment of novel therapeutic agents that target the underlyingpathological angiogenic process. Among these, VEGF serves as a “masterswitch” for many ocular neovascular conditions through its promotion ofendothelial cell proliferation and survival, vascular permeability andocular inflammation. Anti-VEGF agents are now available, such asaflibercept (EYLEA™), bevacizumab (AVASTIN™, ranibizumab (LUCENTIS™) andpegaptanib sodium (MACUGEN™), an aptamer for neovascular AMD. Unlikebevacizumab, which binds all VEGF isoforms, pegaptanib targets onlyVEGF165, the isoform responsible for pathological ocularneovascularization.

Flt-1 (VEGFR-1; Unitprot ID: P17948) is one of the two human receptorsfor vascular endothelial growth factor. The other being KDR (VEGFR-2;Uniprot ID: P35968). The flt-1 protein consists of an external domaincontaining seven immunoglobulin like domains, a transmembrane region anda cytoplasmic region containing a tyrosine kinase domain. In contrast toother members of the receptor tyrosine kinase family, the kinase domainof flt-1 is in two segments with an intervening sequence of ˜70 aminoacids. The biology of the VEGF receptors has been reviewed (Neufeld etal., (1999) FASEB Journal. 13:11-22; Zachary (1998) ExperimentalNephrology. 6:480-487) and the tyrosine phosphorylation sites have beenidentified (Ito et al., (1998) J. Biol. Chem. 273:23410-23418).

It is thought that flt-1 may be important in regulating the tissuearchitecture in developing vasculature while the second VEGF receptor(KDR, VEGFR-2) mediates the mitogenic and angiogenic effects of VEGF inendothelial cells. Evidence to support this theory has come fromknockout studies in mice (Fong et al., (1995) Nature. 376:66-70). VEGFand its receptors are over expressed in many tumour types and blockingof VEGF function inhibits angiogenesis and suppresses growth of tumourswhile over expression of VEGF enhances angiogenesis and tumour growth(Skobe et al., (1997) Nature Medicine 3:1222-1227).

The flt-1 cDNA (EMBL Accession Number X51602, 7680 bp) encodes a matureprotein of 1338 amino acids. The structure of the murine flt-1 gene hasbeen determined (Kondo et al., (1998) Gene 208:297-305) and has beenused to predict the intron/exon boundaries within the human gene. Thepromoter region of the human gene has been characterised (Ikeda et al.,(1996) Growth Factors. 13:151-162; Morishita et al., (1995) J Biol Chem270:27948-27953; EMBL Accession Number D64016,1745 bp). The flt-1 gene,which is organised into thirty exons, has been localised to chromosome13_(q)12 (Rosnet et al. (1993) Oncogene 8:73-179). See EP1130123A2.

Diabetic Retinopathy (DR)

Diabetic retinopathy (DR), a micro-vascular complication of diabetes, isa main cause of blindness in adults. It is well established that DR isdetermined by both genetic and environmental factors. The longerduration of diabetes, poorer control of blood glucose and elevated bloodpressure are the major risk factors in the development of DR. However,genetic factors also play important roles in the pathogenesis of DR.Over the past three decades, the number of people with diabetes mellitushas more than doubled globally, making it one of the most importantpublic health challenges to all nations. DR occurs in 75% of patientswith type 2 diabetes mellitus and almost all patients with type 1diabetes mellitus within 15 years of the manifestation of diabetes.Evidence supports an important role for genetics in determining risk forDR.

VEGF-A has been implicated as a major contributor to the development ofDR. VEGF-A could induce the earliest changes in DR includingleukostasis, blood-retinal barrier breakdown, and macular edema andneovascularization in progression of DR. The VEGF-A gene is located onhuman chromosome 6p21.3 and consists of 8 exons. The genetic variants inthe VEGF-A gene are suggested to influence levels of VEGF-A proteinexpression. To date, many studies have investigated the associationsbetween polymorphisms in the VEGF-A gene in humans and DR. −634G/C(+405G/C or rs2010963) polymorphism in the 5-untranslated region and−2578C/A (−25491/D (in high linkage disequilibrium with −2578C/A) orrs699947) polymorphism in the promoter region of the VEGF-A gene havebeen investigated.

Age-Related Macular Degeneration (AMD)

Age-related macular degeneration (AMD) is a neurodegenerative diseasethat leads to visual impairment and accounts for half of all cases ofregistered blindness in Western individuals older than 65 years of age.There are approximately eight million people in the United States withsymptoms of early or intermediate AMD, of whom approximately one millionwill develop advanced AMD within the next five years. AMD is estimatedto affect about 50 million people worldwide, and an increase in agingpopulations makes AMD a significant public health concern and a majorfocus of research efforts. AMD is a clinically heterogeneous andgenetically complex disease, with multiple environmental and geneticrisk factors involved. While epidemiological studies have linkedcigarette smoking, alcohol consumption, light exposure, diet, drugs, andhigh blood pressure to the risk of AMD, familial aggregation and twinstudies have suggested that genetic variation may also play an importantrole in the disease.

Anti-VEGF therapies are now regarded as the standard of care in thetreatment of neovascular AMD. Two of the most widely used treatments areranibizumab and bevacizumab. Ranibizumab (Lucentis®, Genentech, CA,USA), a US FDA-approved anti-VEGF therapy for AMD, is a recombinant,fragmented, monoclonal antibody that binds to VEGF. On the other hand,bevacizumab (Avastin®, Genentech), although not FDA approved for oculartreatment, is a full-length monoclonal antibody reportedly with similarfunction as that of ranibizumab. Bevacizumab, FDA approved formetastatic colon cancer, has been given as an off-label treatment forocular angiogenic disorders. An individual's genetic variation mayaffect the treatment response in both of these drugs.

Polypoidal Choroidal Vasculopathy (PCV)

A subset of wet AMD, termed polypoidal chorio-vasculopathy (PCV), hasbeen identified as a clinical entity. PCV is important, as it may be themain cause of vision loss from AMD in certain Asian and

black populations. The distinctive clinical features of PCV include oneor more haemorrhagic pigment epithelial detachments (PEDs), extensiveexudation, and disease outside of the macula including the periphery.There is a predilection for peripapillary ‘polyps’. Patients are alsocharacteristically younger.

There is increasing evidence that Asian patients with neovascular AMDhave a variant of AMD, ie, polypoidal choroidal vasculopathy (PCV),which is characterized by polypoidal lesion with inner choroidal vesselabnormality. PCV is more prevalent in Asian subjects, reportedlyaccounting for about 50% of neovascular AMD compared to 10% inEuropeans. Studies have shown that anti-VEGF therapy (ranibizumab) incombination with photodynamic therapy (PDT) was associated with a morefavorable outcome compared to ranibizumab monotherapy.

Retinal Angiomatous Proliferation (RAP)

Another variant of AMD in the spectrum of occult CNV is retinalangiomatous proliferation (RAP), which represents about 12%-15% ofneovascular AMD. It is associated with proliferation of intraretinalcapillaries with retinal anastomosis or CNV.

Diabetic macular edema (DME)

Diabetic macular edema (DME), the most common cause of visual loss insubjects with diabetes, is a separate classification assessedindependently from the DR spectrum, because it can develop at any stageof DR. The pathogenesis of DR and DME is thought to be related to theloss of pericytes, thickening of basement membrane and endothelial cellloss, leading to microaneurysms, blood-retinal barrier breakdown,increase in inflammation and vascular leakage. There are severaltreatment modalities for DME. The goal of laser treatment of DME is toreduce disease progression by targeting areas of leakage on the retina.Intravitreal triamcinolone acetonide (IVTA) has also been shown tosignificantly reduce DME, with maximal action at one week and lasting3-6 months.

Retinal-Vein Occlusion (RVO)

Retinal-vein occlusion (RVO) is the most common retinal vasculardisorder after diabetic retinopathy in the elderly and is oftenassociated with systemic disorders, such as hypertension,hyperlipidemia, diabetes mellitus and/or arteriosclerotic vasculardisorders. It is classified as branch retinal vein occlusion (BRVO) orcentral retinal vein occlusion (CRVO), depending on the site ofocclusion and further divided into ischemic (non-perfusion) ornon-ischemic (perfusion) RVO, each with differing prognosis andtreatment. Macular edema and retinal neovascularization are the two mostcommon causes of visual impairments; thus, ocular managements with laserphotocoagulation, intravitreal injections of glucocorticoids oranti-VEGF agents, as well as other surgical or systemic therapies, havefocused on these two sequelae.

Retinopathy of Prematurity (ROP)

ROP remains one of the leading causes of childhood blindness. In latestages of ROP, neovascularization of abnormal or pathological vesselsarise, due to retinal immaturity, and lead to retinal traction,detachment, hemorrhage and funnel configuration, eventually resulting inpoor vision. Neovascularization is mainly driven by VEGF, and currently,the recommended treatment for Type-1 ROP is peripheral ablation bylaser.

Angiogenesis & Angiogenesis Inhibitors

Angiogenesis is the formation of new blood vessels. This processinvolves the migration, growth, and differentiation of endothelialcells, which line the inside wall of blood vessels. The process ofangiogenesis is controlled by chemical signals in the body. Thesesignals can stimulate both the repair of damaged blood vessels and theformation of new blood vessels. Other chemical signals, calledangiogenesis inhibitors, interfere with blood vessel formation.Normally, the stimulating and inhibiting effects of these chemicalsignals are balanced so that blood vessels form only when and where theyare needed. Neovascularization is the formation of functionalmicrovascular networks with red blood cell perfusion. Neovascularizationdiffers from angiogenesis in that angiogenesis is mainly characterizedby the protrusion and outgrowth of capillary buds and sprouts frompre-existing blood vessels.

Angiogenesis plays a critical role in the growth and spread of cancer. Ablood supply is necessary for tumours to grow beyond a few millimetersin size. Tumours can cause this blood supply to form by giving offchemical signals that stimulate angiogenesis. Tumours can also stimulatenearby normal cells to produce angiogenesis signalling molecules. Theresulting new blood vessels “feed” growing tumours with oxygen andnutrients, allowing the cancer cells to invade nearby tissue, to movethroughout the body, and to form new colonies of cancer cells, calledmetastases. Because tumours cannot grow beyond a certain size or spreadwithout a blood supply, research is focused on trying to find ways toblock tumour angiogenesis, with the idea that angiogenesis inhibitorswill prevent or slow the growth of cancer. Similarly, ocular diseasesand conditions, such as AMD and DR are associated with angiogenesis, andinhibitors are useful for the treatment or prevention of these too.

Thus, anti-VEGF (ie, VEGF-A) ligands and antibodies of the invention areuseful for treating, preventing or reducing the risk of one or more ofsuch ocular conditions and cancer (eg, solid tumours).

Angiogenesis requires the binding of signalling molecules, such asvascular endothelial growth factor (VEGF), to receptors on the surfaceof normal endothelial cells. When VEGF and other endothelial growthfactors bind to their receptors on endothelial cells, signals withinthese cells are initiated that promote the growth and survival of newblood vessels. Angiogenesis inhibitors interfere with various steps inthis process. For example, bevacizumab (Avastin®) is an anti-VEGFmonoclonal antibody that specifically recognizes and binds to VEGF.Aflibercept (Eylea®) is a VEGF receptor-Fc fusion that binds VEGF. Otherangiogenesis inhibitors, including sorafenib and sunitinib, bind toreceptors on the surface of endothelial cells or to other proteins inthe downstream signalling pathways, blocking their activities.

In addition to, or alternative to, targeting human VEGF-A to addressocular conditions or cancer (or angiogenesis or neovascularisationgenerally), it may be useful to target the platelet derived growthfactor pathway (eg, targeting PDGF-B and/or PDGFR-B), or theangiopoietin-2 pathway. Further details are provided below.

In an example, the invention provides a method of treating or reducingthe risk of a VEGF-A-mediated disease or condition in a human in needthereof, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human VEGF-Aprotein. The invention also provides a corresponding ligand.

In an example, the invention provides a method of treating or reducingthe risk of a PDGF-B (ie, platelet derived growth factor-beta)-mediateddisease or condition in a human in need thereof, the method comprisingadministering to said human a ligand (eg, an antibody or antibodyfragment) that specifically binds a human PDGF-B protein. The inventionalso provides a corresponding ligand.

The present invention provides anti-VEGF-A ligands; and VEGF-A-bindingor targeting ligands as described herein. The ligands have a variety ofutilities. Some of the ligands, for instance, are useful in specificbinding assays, for genotyping or phenotyping humans, affinitypurification of VEGF-A, in particular human VEGF-A or its ligands and inscreening assays to identify other antagonists of VEGF-A activity. Someof the ligands of the invention are useful for inhibitingVEGF-A-mediated activities.

In an example, the invention provides a method of treating or reducingthe risk of a PDGFR-B (ie, platelet derived growth factor-betareceptor)-mediated disease or condition in a human in need thereof, themethod comprising administering to said human a ligand (eg, an antibodyor antibody fragment) that specifically binds a human PDGFR-B protein.The invention also provides a corresponding ligand.

The present invention provides anti-PDGF-B ligands; and PDGF-B-bindingor targeting ligands as described herein. The ligands have a variety ofutilities. Some of the ligands, for instance, are useful in specificbinding assays, for genotyping or phenotyping humans, affinitypurification of PDGF-B, in particular human PDGF-B or its ligands and inscreening assays to identify other antagonists of PDGF-B activity. Someof the ligands of the invention are useful for inhibitingPDGF-B-mediated activities.

The present invention provides anti-VEGF-A ligands; and VEGF-A-bindingor targeting ligands as described herein. The ligands have a variety ofutilities. Some of the ligands, for instance, are useful in specificbinding assays, for genotyping or phenotyping humans, affinitypurification of VEGF-A, in particular human VEGF-A or its ligands and inscreening assays to identify other antagonists of VEGF-A activity. Someof the ligands of the invention are useful for inhibitingVEGF-A-mediated activities.

The present invention provides anti-PDGFR-B ligands; and PDGFR-B-bindingor targeting ligands as described herein. The ligands have a variety ofutilities. Some of the ligands, for instance, are useful in specificbinding assays, for genotyping or phenotyping humans, affinitypurification of PDGFR-B, in particular human PDGFR-B or its ligands andin screening assays to identify other antagonists of PDGFR-B activity.Some of the ligands of the invention are useful for inhibitingPDGFR-B-mediated activities.

Anti-VEGF-A ligands (eg, antibodies and anti-sense RNA) have beendeveloped based on targeting and neutralising so-called “wild-type”human VEGF-A, which is a commonly-occurring form. While such therapiesare useful for human patients harbouring this form of human VEGF-A, theinventor considered it useful to investigate the possibility oftargeting rarer—but still naturally-occurring—forms of VEGF-A amongsthuman populations. In this way, the inventor arrived at insight into thenatural occurrences and distributions of rarer human VEGF-A forms thatcan serve as useful targets (at the protein or nucleic acid level) forhuman treatment, prophylaxis and diagnosis pertinent to diseases andconditions mediated or associated with VEGF-A activity. Thisparticularly provides for tailored therapies, prophylaxis and diagnosisin humans that are devoid of the common VEGF-A gene or protein.

The skilled person will know that SNPs or other changes that translateinto amino acid variation can cause variability in activity and/orconformation of human targets to be addressed. This has spawned greatinterest in personalized medicine where genotyping and knowledge ofprotein and nucleotide variability is used to more effectively tailormedicines and diagnosis of patients. The invention, therefore, providesfor tailored pharmaceuticals and testing that specifically addressesrarer VEGF-A polymorphic variant forms. Such forms or “alleles” (at thenucleotide level), comprise one or more changes at the nucleotide andamino acid levels from the corresponding common form nucleotide andamino acids sequences, ie, there are one or more non-synonymous (aka“missense”) changes at the nucleotide level that translate into one ormore corresponding changes in the protein target in humans.

Furthermore, the inventor surprisingly realised that the rarer naturalforms, although present in humans at much lower frequencies than thecommon form, nevertheless are represented in multiple andethnically-diverse human populations and usually with many humanexamples per represented ethnic population. Thus, the inventor realisedthat targeting such rarer forms would provide for effective treatment,prophylaxis or diagnosis across many human ethnic populations, therebyextending the utility of the present invention. In particular, humanVEGF-A variations are correlated with increased incidence or risk ofVEGF-A mediated diseases or conditions, such as ocular conditions orcancer. Additionally or alternatively, VEGF-A variations are correlatedwith improved responses following treatments for ocular conditions. Theinventor analysed such variations and devised the collections ofvariants in Tables 18-20. As shown in those tables, the inventor alsoassessed variation in other human targets that also correlate toincidence or risk of diseases or conditions, such as ocular conditionsor cancer, or improved responses following treatments for ocularconditions. In this respect, therefore, the invention provides variousaspects and concepts as set out below in this example.

The inventor saw that there is significant industrial and medicalapplication for the invention in terms of guiding the choice of anti-TOI(VEGF-A, PDGF-B and/or PDGFR-B) ligand for administration to humanpatients for therapy and/or prophylaxis of VEGF-A, PDGF-B and/orPDGFR-B-mediated or associated diseases or conditions. In this way, thepatient receives drugs and ligands that are tailored to their needs—asdetermined by the patient's genetic or phenotypic makeup. Hand-in-handwith this, the invention provides for the genotyping and/or phenotypingof patients in connection with such treatment, thereby allowing a propermatch of drug to patient. This increases the chances of medicalefficacy, reduces the likelihood of inferior treatment using drugs orligands that are not matched to the patient (eg, poor efficacy and/orside-effects) and avoids pharmaceutical mis-prescription and waste.

In developing this thinking, in a non-limiting embodiment the presentinventor decided to determine a set of human VEGF-A, PDGF-B and PDGFR-Bvariants on the basis of the following criteria, these being criteriathat the inventor realised would provide for useful medical drugs anddiagnostics to tailored need in the human population. The inventorselected variants having at least 3 of the 4 following criteria:—

Naturally-occurring human TOI (VEGF-A, PDGF-B or PDGFR-B) variationhaving a cumulative human allele frequency of 35% or less;

Naturally-occurring human TOI variation having a total human genotypefrequency of about 50% or less;

Naturally-occurring human TOI variation found in many different humanethnic populations (using the standard categorisation of the 1000Genomes Project; see Table 2 below); and

Naturally-occurring human TOI variation found in many individualsdistributed across such many different ethnic populations.

On the basis of these criteria, the inventor identified variants listedbelow.

Furthermore, the inventor identified useful variations also in thefollowing human TOIs: complement factor H (CFH), complement component 2(C2), prothrombin, methylenetetrahydrofolate reductase (MTHFR), FactorV, ARMS2, VEGFR2 and HTRA1. As the titles to Tables 18-20 indicate, theexaminer realised that such variants have useful correlations.

In an example, the ligand of the invention comprises an anti-TOI (eg,anti-human VEGF-A) binding site, wherein the binding site is a human orhumanized binding site, eg, the binding site comprises or consists of ahuman or humanized antibody variable domain or plurality of variabledomains (eg, human VH/VL binding site(s)). Additionally oralternatively, the ligand comprises one or more human antibody constantregions (eg, a human antibody CH1, CH2, CH3 (or all of these) or Fc). Inan example, the ligand is an antibody that comprises human or humanizedvariable regions and human constant regions (eg, bearing one or moremutations to enhance or dampen Fc function in a human patient).

In an example, the invention provides a method of targeting VEGF-A in ahuman, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human VEGF-Aprotein that is encoded by a human VEGF-A nucleotide comprising a VEGF-ASNP as described herein. In an example, the human is suffering from orat risk of a VEGF-A-mediated disease or condition. In an example, themethod treats or reduces the risk of a VEGF-A-mediated disease orcondition in the human. In an example, the condition comprisesangiogenesis or neovascularisation.

In an example, the invention provides a method of targeting PDGF-B in ahuman, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human PDGF-Bprotein that is encoded by a human PDGF-B nucleotide comprising a PDGF-BSNP as described herein. In an example, the human is suffering from orat risk of a PDGF-B-mediated disease or condition. In an example, themethod treats or reduces the risk of a PDGF-B-mediated disease orcondition in the human. In an example, the condition comprisesangiogenesis or neovascularisation.

In an example, the invention provides a method of targeting PDGFR-B in ahuman, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a humanPDGFR-B protein that is encoded by a human PDGFR-B nucleotide comprisinga PDGFR-B SNP as described herein. In an example, the human is sufferingfrom or at risk of a PDGFR-B-mediated disease or condition. In anexample, the method treats or reduces the risk of a PDGFR-B-mediateddisease or condition in the human. In an example, the conditioncomprises angiogenesis or neovascularisation.

In an embodiment, (i) the antibody or fragment comprises a VH domainderived from the recombination of a human VH segment, a human D genesegment and a human JH segment, the human VH segment encoding theframework 1 of SEQ ID NO: 40 and wherein said human comprises a VH genesegment encoding the framework 1 of SEQ ID NO: 40, or the humanexpresses VH domains that comprise the framework 1 of SEQ ID NO: 40; andwherein (ii) said human comprises said nucleotide sequence encoding saidVEGF-A, PDGF-B or PDGFR-B.

Additionally or alternatively, in an embodiment, (i) the antibody orfragment comprises a human gamma-4 heavy chain constant region thatcomprises a Leu at position 189 shown in SEQ ID NO: 73 or an Arg atposition 289 shown in SEQ ID NO: 73 and wherein said human comprises anIGHG4*01 human heavy chain constant region gene segment, or the humanexpresses antibodies comprising human gamma-4 heavy chain constantregions comprising a Leu at position 189 shown in SEQ ID NO: 73 or anArg at position 289 shown in SEQ ID NO: 73; and wherein (ii) said humancomprises said nucleotide sequence encoding said VEGF-A, PDGF-B orPDGFR-B.

In a specific embodiment, the anti-VEGF-A, PDGF-B or PDGFR-B ligand,antibody or fragment of present invention comprises an Fc region,wherein the Fc region comprises at least one non-native amino acidresidue selected from the group consisting of 234D, 234E, 234N, 234Q,234T, 234H, 234Y, 234I, 234V, 234F, 235A, 235D, 235R, 235W, 235P, 235S,235N, 235Q, 235T, 235H, 235Y, 235I, 235V, 235F, 236E, 239D, 239E, 239N,239Q, 239F, 239T, 239H, 239Y, 240I, 240A, 240T, 240M, 241W, 241 L, 241Y,241E, 241R. 243W, 243L 243Y, 243R, 243Q, 244H, 245A, 247L, 247V, 247G,251F, 252Y, 254T, 255L, 256E, 256M, 262I, 262A, 262T, 262E, 263I, 263A,263T, 263M, 264L, 264I, 264W, 264T, 264R, 264F, 264M, 264Y, 264E, 265G,265N, 265Q, 265Y, 265F, 265V, 265I, 265L, 265H, 265T, 266I, 266A, 266T,266M, 267Q, 267L, 268E, 269H, 269Y, 269F, 269R, 270E, 280A, 284M, 292P,292L, 296E, 296Q, 296D, 296N, 296S, 296T, 296L, 296I, 296H, 269G, 297S,297D, 297E, 298H, 298I, 298T, 298F, 299I, 299L, 299A, 299S, 299V, 299H,299F, 299E, 305I, 313F, 316D, 325Q, 325L, 325I, 325D, 325E, 325A, 325T,325V, 325H, 327G, 327W, 327N, 327L, 328S, 328M, 328D, 328E, 328N, 328Q,328F, 328I, 328V, 328T, 328H, 328A, 329F, 329H, 329Q, 330K, 330G, 330T,330C, 330L, 330Y, 330V, 330I, 330F, 330R, 330H, 331G, 331A, 331L, 331M,331F, 331W, 331K, 331Q, 331E, 331S, 331V, 331I, 331C, 331Y, 331H, 331R,331N, 331D, 331T, 332D, 332S, 332W, 332F, 332E, 332N, 332Q, 332T, 332H,332Y, 332A, 339T, 370E, 370N, 378D, 392T, 396L, 416G, 419H, 421K, 440Yand 434W as numbered by the EU index as set forth in Kabat. Optionally,the Fc region may comprise additional and/or alternative non-nativeamino acid residues known to one skilled in the art (see, e.g., U.S.Pat. Nos. 5,624,821; 6,277,375; 6,737,056; PCT Patent Publications WO01/58957; WO 02/06919; WO 04/016750; WO 04/029207; WO 04/035752 and WO05/040217).

The ligand, antibody or fragment according to the invention (eg, ananti-VEGF-A ligand, antibody or fragment) is for treating or preventingor reducing the risk of (or treats or prevents or reduces the risk of),for example, any disease or condition disclosed in US2012064621A1 orUS7704500B2, the disclosure of which diseases and conditions areincorporated herein by reference for potential inclusion in one or moreclaims herein. Guidance on obtaining and testing antibodies can also befound in that PCT application. Suitable anti-VEGF-A ligands, antibodiesor fragments for use in the invention are disclosed in US2012064621A1 orUS7704500B2, the disclosure of which (including sequences thereof) areincorporated herein by reference for potential inclusion in one or moreclaims herein.

Further encompassed by the invention is the use of the anti-TOI (eg,VEGF-A) ligand, antibody or fragment of an in the manufacture of amedicament for use to attenuate or inhibit a TOI (eg, VEGF-A)-mediateddisease or disorder in a human. VEGF-A-mediated or related disorderswhich are treated by the ligand, antibody or fragment of the inventioninclude, for example, described below.

Thus, a ligand, antibody or fragment of the invention is useful as atherapeutic agent in the treatment of a condition involving TOI (eg,VEGF-A) expression and/or activity. One embodiment, among others, is amethod of treatment comprising administering an effective amount of aligand, antibody or fragment of the invention to a patient in needthereof, wherein functional consequences of TOI activation aredecreased. Another embodiment, among others, is a method of treatmentcomprising (i) identifying a patient demonstrating TOI expression oractivity, and (ii) administering an effective amount of a ligand,antibody or fragment of the invention to the patient, wherein afunctional consequence of TOI activation are attenuated. An effectiveamount according to the invention is an amount that modulates (e.g.decreases) the functional consequences of TOI activation so as tomodulate (e.g. decrease or lessen) the severity of at least one symptomof the particular disease or disorder being treated, but not necessarilycure the disease or disorder. Accordingly, one embodiment of theinvention is a method of treating or reducing the severity of at leastone symptom of any of the disorders referred to herein, comprisingadministering to a patient in need thereof an effective amount of one ormore ligands, antibodies or fragments of the present invention alone orin a combined therapeutic regimen with another appropriate medicamentknown in the art or described herein such that the severity of at leastone symptom of any of the disorders is reduced. Another embodiment ofthe invention, among others, is a method of antagonizing at least oneeffect of TOI comprising contacting with or administering an effectiveamount of one or more ligands, antibodies or fragments of the presentinvention such that said at least one effect of TOI is antagonized, e.g.the ability to promote or maintain angiogenesis or neovascularisation.

Tailoring Antibodies to Rarer TOI (VEGF-A, PDGF-B or PDGFR-B) VariantProfile

As outlined herein (for example, in the context of PCSK9 in Example 1),the invention includes the possibility to tailor treatment of humansfurther by selecting antibody-based ligands with variable domains and/orconstant domains based on gene segments found in many humans of theethnic populations where the variant TOI forms are found to meet theselection criteria of the invention. This also applies mutatis mutandiswhere the TOI is human VEGF-A, PDGF-B or PDGFR-B as in the presentexample. Thus, all disclosure herein relating to tailoring variableand/or constant domains apply to the present example, relating toVEGF-A, PDGF-B or PDGFR-B and is combinable for use in one or moreclaims herein.

As described in Example 1, an example is provided for ligands comprisingantibody VH domains derived from recombination of human IGHV genesegments comprising selected nucleotides at positions in the HCDR1 orFW3 where there is variability in humans (ie, where SNPs occur inhumans).

Further information is provided in Table 4, which shows variation atthese positions, as well as the variant distributions across the 1000Genomes Project database relating to many human populations.

In other embodiments, as explained more fully above, the inventionprovides for ligands which are tailored to the human recipient'sgenotype and/or phenotype based on alternative human VH gene segments,or on Vκ, Vλ or constant region gene segments (see further Table 9 forrepresentative variants).

Further examples, therefore are:—

(i) wherein the ligand comprises a VH domain derived from therecombination of a human VH segment (eg, human VH3-23*04), a human Dgene segment and a human JH segment, the human VH segment encoding theframework 1 of SEQ ID NO: 40 and wherein said human comprises a VH genesegment encoding the framework 1 of SEQ ID NO: 40, or the humanexpresses VH domains that comprise the framework 1 of SEQ ID NO: 40.(ii) wherein the ligand comprises a VH domain derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment, and wherein said human comprises a IGHV3-7*01 VHgene segment or the human expresses VH domains derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment.(iii) wherein the ligand comprises a Vκ domain derived from therecombination of human Vκ segment IGKV1-12*01 and a human Jκ segment,and wherein said human comprises a IGKV1-12*01 Vκ gene segment or thehuman expresses Vκ domains derived from the recombination of human Vκsegment IGKV1-12*01 and a human Jκ segment.(iv) wherein the ligand comprises a Vκ domain derived from therecombination of a human Vκ segment and a human Jκ segment, the human Vκsegment encoding (i) a CDR3 comprising a Pro at position 7 shown in SEQID NO: 36 and wherein said human comprises a Vκ gene segment encoding aCDR3 comprising a Pro at position 7 shown in SEQ ID NO: 36, or the humanexpresses Vκ domains that comprise a CDR3 comprising a Pro at position 7shown in SEQ ID NO: 36; or (ii) a FW3 comprising a Ser at position 15shown in SEQ ID NO: 38 and wherein said human comprises a Vκ genesegment encoding a FW3 comprising a Ser at position 15 shown in SEQ IDNO: 38 or the human expresses Vκ domains that comprise a FW3 comprisinga Ser at position 15 shown in SEQ ID NO: 38.(v) wherein the ligand comprises a human gamma-1 heavy chain constantregion that comprises an Asp at position 204 shown in SEQ ID NO: 4 or aLeu at position 206 shown in SEQ ID NO: 4 and wherein said humancomprises (i) an IGHG1*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-1heavy chain constant regions comprising an Asp at position 204 shown inSEQ ID NO: 4 or a Leu at position 206 shown in SEQ ID NO: 4.(vi) wherein the ligand comprises a human gamma-2 heavy chain constantregion that comprises an amino acid selected from the group consistingof a Pro at position 72 shown in SEQ ID NO: 6, an Asn at position 75shown in SEQ ID NO: 6, a Phe at position 76 shown in SEQ ID NO: 6, a Valat position 161 shown in SEQ ID NO: 6 and an Ala at position 257 shownin SEQ ID NO: 6 and wherein said human comprises (i) an IGHG2*01 humanheavy chain constant region gene segment, or the human expressesantibodies comprising human gamma-2 heavy chain constant regionscomprising said selected Pro at position 72 shown in SEQ ID NO: 6, Asnat position 75 shown in SEQ ID NO: 6, Phe at position 76 shown in SEQ IDNO: 6, Val at position 161 shown in SEQ ID NO: 6 or Ala at position 257shown in SEQ ID NO: 6.(vii) wherein the ligand comprises a human kappa chain constant regionthat comprises a Val at position 84 shown in SEQ ID NO: 16 or a Cys atposition 87 shown in SEQ ID NO: 16 and wherein said human comprises (i)an IGKC1*01 human kappa chain constant region gene segment, or the humanexpresses antibodies comprising human kappa chain constant regionscomprising a Val corresponding to position 84 shown in SEQ ID NO: 16 ora Cys at position 87 shown in SEQ ID NO: 16.(viii) wherein the ligand comprises a human IGLC1*01 lambda chainconstant region and wherein said human comprises (i) a human IGLC1*01lambda chain constant region gene segment, or the human expressesantibodies comprising human IGLC1*01 lambda chain constant regions.(ix) wherein the ligand comprises a human gamma-4 heavy chain constantregion that comprises a Leu at position 189 shown in SEQ ID NO: 73 or anArg at position 289 shown in SEQ ID NO: 73 and wherein said humancomprises (i) an IGHG4*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-4heavy chain constant regions comprising a Leu at position 189 shown inSEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73.(x) wherein the ligand comprises a human gamma-3 heavy chain constantregion encoded by a first human IGHG3 (eg, IGHG3*01) constant regiongene segment and wherein said human comprises (i) said first constantregion gene segment (eg, an IGHG3*01), or the human expresses antibodiescomprising human gamma-3 heavy chain constant regions encoded by saidfirst human IGHG3 (eg, IGHG3*01) constant region gene segment.(xi) wherein the ligand comprises a human epsilon heavy chain constantregion encoded by a first human epsilon heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human epsilonheavy chain constant regions encoded by said first constant region genesegment.(xii) wherein the ligand comprises a human mu heavy chain constantregion encoded by a first human mu heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human muheavy chain constant regions encoded by said first constant region genesegment.(xiii) wherein the ligand comprises a human alpha heavy chain constantregion encoded by a first human alpha heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human alphaheavy chain constant regions encoded by said first constant region genesegment.(xiv) wherein the ligand comprises a human delta heavy chain constantregion encoded by a first human delta heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human deltaheavy chain constant regions encoded by said first constant region genesegment.(xv) wherein the ligand comprises a human kappa light chain constantregion encoded by a first human kappa light chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human kappalight chain constant regions encoded by said first constant region genesegment.(xvi) wherein the ligand comprises a human lambda light chain constantregion encoded by a first human lambda light chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human lambdalight chain constant regions encoded by said first constant region genesegment.

It may be advantageous for VEGF-A, PDGF-B or PDGFR-B ligands, for theligand to comprise a gamma-1 or gamma-2 constant region (eg, as per theembodiments (i) to (xvi) above). For example, the ligand comprises saidgamma-1 constant region, eg, an ADCC or CDC enhanced constant regionmeeting embodiment (v).

Determination of Specific Binding of Ligands of the Invention to VEGF-A,PDGF-B or PDGFR-B Variants

The specific binding of ligands of the invention to VEGF-A, PDGF-B orPDGFR-B variants can be performed using the SPR method described inExample 1.

Human Polymorphisms

REFERENCES

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A total of 1525 DR cases and 1422 diabetic    without retinopathy (DWR) controls in 9 independent studies were    included in the meta-analysis. A significant relationship between    VEGF −634G>C polymorphism and DR was found in an allelic genetic    model (OR: 1.13, 95% CI: 1.01 to 1.25, P=0.03) and a recessive    genetic model (OR: 1.26, 95% CI: 1.02 to 1.55, P=0.03). The authors    concluded that their research confirmed the association between the    VEGF −634G>C polymorphism and DR in subjects with type 2    diabetes. 5. Diabetes. 2002 May; 51(5):1635-9, “A common    polymorphism in the 5′-untranslated region of the VEGF gene is    associated with diabetic retinopathy in type 2 diabetes”, Awata T et    al. These authors suggest that the −634G>C polymorphism in the 5′UTR    of the VEGF gene is a genetic risk factor for diabetic retinopathy.-   6. Molecular Vision 2010;    16:1958-1981<http://www.molvis.org/molvis/v16/a213>, Tong Y et al.    In conclusion, according to the authors the described Human Genome    Epidemiology (HuGE) systematic review presents strong evidence for    an association between the HTRA1 rs11200638 G→A polymorphism,    LOC387715/ARMS2rs10490924 G→T polymorphism, and AMD, and suggests    that both of these genes play important roles in this disease.    Potential gene-gene and gene-environmental interactions and possible    mechanisms of AMD are also summarized and discussed.-   7. J. Pers. Med. 2013, 3, 40-69; doi:10.3390/jpm3010040,    “Personalized Medicine in Ophthalmology: From Pharmacogenetic    Biomarkers to Therapeutic and Dosage Optimization”, Frank S Ong et    al. This review comments that: In the case of intravitreal    bevacizumab, CFHY402H genotypes, TC and TT, show more than five-fold    increased improvement compared to the CC genotype. The data shows    that after treatment with bevacizumab, visual acuity of the patients    improved from 20/248 to 20/166 (TT) and from 20/206 to 20/170 (TC),    but actually decreased from 20/206 to 20/341 for the CC genotype    (p=0.016). In a prospective study with twice the number of patients,    the CC genotype was confirmed to have worse outcome as measured by    distance and reading visual acuity. In a similar experiment with    intravitreal ranibizumab, the TC and TT genotypes for CFH showed    improvement with fewer injections compared to the CC genotype.    Recurrent analysis showed that patients homozygous for the CFHY402H    risk allele (CC) were 37% more likely to require additional    ranibizumab injections (p=0.04). Another study found that    individuals homozygous for 69S in ARMS2 had decreased central    subfield retinal thickness and no improvement in visual outcomes    compared to improved visual acuity in ARMS2 rs10490924 and rs1061170    genotypes following ranibizumab treatment. Taking genetics and    environmental factors together, the CFH Y402H homozygous CC genotype    with BMI >30 and smoking reportedly conferred the greatest risk.-   8. Expert Rev Ophthalmol. 2013 Apr. 1; 8(2): 127-140.    doi:10.1586/eop.13.3, “Genetic risk, ethnic variations and    pharmacogenetic biomarkers in age-related macular degeneration and    polypoidal choroidal vasculopathy”, Jane Z. Kuo et al. This article    comments that: Variants in the complement factor H (CFH) gene    confers a 7.4-fold increased likelihood of late AMD. AMD is a common    complex disorder with complex inheritance patterns due to various    gene and environmental interactions. Yet, despite these challenges,    AMD represents an unusual example of the “common disease common    variant” theory in which several variants identified on the CFH gene    have relatively large effects on disease outcome. Even though the    most well-established and consistent association of AMD is observed    with complement factor H (CFH) on chromosome 1, recent studies have    also shown that other candidate genes in the complement pathway,    ARMS2/HTRA1 on chromosome 10q26, LIPC, CETP, and TIMP2 are also    susceptible loci associated with AMD. In 2005, three independent    research groups identified a common coding variant, Y402H    (rs1061170), in the CFH gene on chromosome 1 that was strongly    associated with susceptibility of AMD, with reported odds ratio (OR)    ranging from 2.5 to 3.3 for all AMD and as high as 7.4 for advanced    AMD. The Y402H variant results in a tyrosine-to-histidine    substitution. The association of CFH in AMD implicated that the    complement cascade plays a critical role in the development of AMD    and is now also regarded as a major contributor to susceptibility of    AMD. In addition to CFH and the complement pathway, the region at    chromosome 10q26 also harbors additional signals to AMD    susceptibility, namely the age-related maculopathy susceptibility 2    (ARMS2) and the high-temperature requirement factor H (HTRA1) genes.    It is also possible that susceptible variants within ARMS2 modulate    the promoter activity of HTRA1, so that both ARMS2/HTRA1 contribute    to AMD susceptibility. In one European study, the SNP rs11200638 at    the promoter region of HTRA1 confers a 49.3% attributable risk and    the risk allele was associated with an elevated mRNA and protein    expression and level of HTRA1. The risk allele of the same SNP was    highly significant in the Chinese and has 10 times the risk of    developing AMD compared to subjects with the wild-type allele. Two    VEGF polymorphisms, rs699947 and rs2146323, were significantly    associated with PDT treatment response. The allele frequency of    rs699947 for AA, AC, and CC were 14%, 39%, and 46% in non-responders    versus 40%, 48%, and 12% in responders, respectively (p=0.0008). The    allele frequency of rs2146323 for AA, AC, and CC were 4%, 32%, and    64% in non-responders versus 24%, 38%, and 38% in responders,    respectively (p=0.0369). Thus, the C allele in both SNPs in VEGF    were associated with a higher rate of non-responder to PDT (p=0.0003    for rs699947 and p=0.0036 for rs2146323). In classic choroidal    neovascularization (CNV), prothrombin (G20210A) and MTHFR (C677A)    were significantly associated with PDT responders. In occult CNV,    prothrombin (G20210A) and factor V (G1691A) were significantly    associated with PDT responders. Two studies have showed a worse    visual improvement in subjects with the homozygous TT risk allele at    ARMS2 rs10490924 (A69S) after ranibizumab or bevacizumab injections.    Other candidate gene studies found that patients with the risk    genotype (CC) at rs1413711 of VEGF has a more significant visual    gain after ranibizumab, the G allele at rs699946 of VEGF was    significantly associated with a better visual prognosis after either    intravitreal bevacizumab or triple therapy (PDT with intravitreal    bevacizumab and triamcinolone acetonide). In a study examining the    cumulative effect of risk alleles at CFH (Y402H; rs1061170), ARMS2    (A69S; rs10490924), VEGF (rs699947 and rs833069), KDR (rs2071559 and    rs7671745), LPR5 (rs3736228), and FZD4 (rs10898563) after    ranibizumab treatment, subjects without the high-risk alleles in CFH    and ARMS2 have significantly more visual improvement compared to    subjects with the high-risk alleles (p=0.009). The mean visual    acuity improvement was 10 letters in subjects without the 4-risk    alleles, compared to no improvement in subjects with all 4-risk    alleles. By adding VEGF into the model, they found that subjects    with all 6-risk alleles in CFH, ARMS2, and VEGF demonstrated a mean    loss of 10 letters after ranibizumab treatment, whereas the other    allele groups all demonstrated improvement (p<0.0001), suggesting a    cumulative effect of the risk alleles with a poorer response rate to    treatment. A comprehensive meta-analysis found variants at    ARMS2/HTRA1 (rs10490924, OR=2.27, p<0.00001; rs11200638, OR=2.72,    p<0.00001), CFH (rs1061170, OR=1.72, p<0.00001; rs800292, OR=2.10,    p<0.00001) or the complement pathway (C2; rs547154, OR=0.56, p=0.01)    were significantly associated with PCV, with higher odds ratio    observed at variants in ARMS2/HTRA1. The strong association of    ARMS2/HTRA1 to PCV was supported by numerous studies of Asian    populations.-   9. Survey of Ophthalmology, Volume 59, Issue 1, January-February    2014, Pages 1-18, “Predictors of anti-VEGF treatment response in    neovascular age-related macular degeneration”, Finger et al. The    authors reviewed evidence on predictors of anti-vascular endothelial    growth factor (VEGF) treatment response in neovascular age-related    macular degeneration. Just under half of the SNPs assessed in the    CFH gene and 15% of the SNPs assessed in the VEGF gene were found to    be associated with visual outcomes or the number of injections    required during follow-up.-   10. Ophthalmology. 2013 January; 120(1):115-21. doi:    10.1016/j.ophtha.2012.10.006. Epub 2012 Nov. 11, “Variants in the    VEGFA gene and treatment outcome after anti-VEGF treatment for    neovascular age-related macular degeneration2, Abedi F et al. The    authors concluded that: Pharmacogenetic association with anti-VEGF    treatments may influence the visual outcomes in neovascular AMD. In    patients with the T allele in tSNP rs3025000, there was a    significantly better visual outcome at 6 months and a greater chance    of the patients belonging to the responder group with anti-VEGF    treatment at 3, 6, and 12 months. The visual acuity (VA) outcomes of    patients harbouring the T allele at SNP rs3025000 were comparable    with those of the pivotal clinical trials but with fewer injections.-   11. Ophthalmology. 2014 April; 121(4):905-10. doi:    10.1016/j.ophtha.2013.10.047. Epub 2013 Dec. 21, “Polymorphisms in    vascular endothelial growth factor receptor 2 are associated with    better response rates to ranibizumab treatment in age-related    macular degeneration”, Hermann M M et al. The authors evaluated the    association of single nucleotide polymorphisms (SNPs) in VEGF genes    and their receptors (VEGFR) with the response rate to ranibizumab in    366 patients with neovascular AMD. Univariate analyses of variance    (ANOVAs) revealed a significant effect of SNP rs4576072 in the    VEGFR2 gene on VA change after 12 months (F[1,235]=14.05; P=0.02). A    stepwise linear regression analysis returned a model (P=0.01) with    SNPs rs4576072 and rs6828477 in the VEGFR2 gene as independent    predictors for VA change after 12 months, with a mean increase in VA    of 0.26 on the logarithm of the minimum angle of resolution (log    MAR) scale in patients with 3 contributing minor alleles compared    with a loss of 0.03 log MAR in patients with no minor allele.-   12. Research and Reports in Neonatology 2011:1 5-11; “VEGF 936C>T is    predictive of threshold retinopathy of prematurity in Japanese    infants with a 30-week gestational age or less”, Yagi M et al. The    authors found that VEGF 936C>T polymorphism and duration of oxygen    administration were independent risk factors for threshold ROP using    a multivariate logistic analysis with adjustment for gestational age    and birth weight.-   13. Clin Cancer Res 2009; 15(17) Sep. 1, 2009, pp 5297-5302, DOI:    10.1158/1078-0432.CCR-08-2576, “The Role of Vascular Endothelial    Growth Factor Genetic Variability in Cancer”, Bryan P. Schneider et    al. The authors comment that recently, genetic variability in VEGF    has been studied as a potential predictive biomarker for    bevacizumab. The VEGF-I154 AA and -2578 AA genotypes predicted an    improved median overall survival, whereas the VEGF-634 CC and -1498    TT genotypes predicted protection from grade 3-4 hypertension in the    pivotal trial, E2100. If validated, these finding could help direct    which subgroup of patients should receive bevacizumab.

The inventor identified the following SNPs as SNPs of interest for thepresent invention.

TABLE 18 POLYMORPHISM RISK FACTORS FOR OCULAR CONDITIONS SNP LOCATIONASSOCIATED POLYMOR- (forward EXAMPLE PHISM SNP ID strand) INDICATIONVEGF-A −2578C > A rs699947 6:43768652 DR −460T > C rs833061 6:43769749DR −634G > C rs2010963 6:43770613 DR +936C > T rs3025039 6:43784799 DRROP A > G rs699946 6:43764932 DR HTRA1 −625G > A rs11200638 10:122461028AMD ARMS2 G > T rs10490924 10:122454932 AMD A69S PCV COMPLEMENT FACTOR H(CFH) 184G > A rs800292 1:196673103 AMD V62I PCV COMPLEMENT COMPONENT 2(C2) 62G > T rs547154 6:31943161 AMD PCV

NB: as is known in the art SNP location is expressed as chromosomenumber:nucleotide position, eg, 6:43768652 is nucleotide number 43768652on human chromosome 6. ARMS2 is also known as age-related maculopathysusceptibility protein 2, ARMD8 and ARMS2_HUMAN LOC387715.

TABLE 19 POLYMORPHISMS ASSOCIATED WITH IMPROVED OCULAR RESPONSES SNPLOCATION ASSOCIATED POLYMOR- (forward EXAMPLE PHISM SNP ID strand)BENEFIT VEGF-A −2578C > A rs699947 6:43768652 AA and AC genotypesassociated with improved PDT response −111C > A rs2146323 6:43777358 AAand AC genotypes associated with improved PDT response −1400T > Crs1413711 6:43772941 CC genotype shows more significant visual gainafter anti-VEGF treatment A > G rs699946 6:43764932 G significantlyassociated with better visual prognosis after anti-VEGF treatment 398G >A rs833068 6:43774790 AA or GG genotype associated with less anti-VEGFtreatment injections needed 450T > C rs833069 6:43774842 AA (TT) or GG(CC) genotype associated with less anti-VEGF treatment injections needed−28C > T rs3025000 6:43778432 T allele associated with visual acuityimprovement with lower anti-VEGF administrations COMPLEMENT FACTOR H(CFH) T > C rs1061170 1:196690107 TC and TT genotypes: Improved visualacuity following anti-VEGF Y402H treatment −2362T > C rs37664041:196682702 TT (AA) genotype associated with less anti-VEGF treatmentinjections needed prothrombin 20210G > A rs1799963 11:46739505Associated with improved PDT response Methylenetetrahydrofolatereductase (MTHFR) 677C > A rs1801133 1:11796321 Associated with improvedPDT response A222V FACTOR V 1691G > A rs6025 1:169549811 Associated withimproved R506Q PDT response ARMS2 G > T rs10490924 10:122454932 GGgenotype associated with improved anti-VEGF A69S response VEGFR2 1026A >G rs4576072 4:55120071 G allele associated with better visual acuityfollowing anti-VEGF 1263G > A rs6828477 4:55100634 A allele associatedwith better visual acuity following anti-VEGF

TABLE 20 POLYMORPHISMS ASSOCIATED WITH IMPROVED CANCER RESPONSES SNPLOCATION ASSOCIATED POLYMOR- (forward EXAMPLE PHISM SNP ID strand)BENEFIT VEGF4-A −2578C > A rs699947 6:43768652 AA genotype associatedwith improved breast cancer response to anti-VEGF −1154G > A rs15703606:43770093 AA genotype associated with improved breast cancer responseto anti-VEGF

The invention thus provides the following concepts:—

Human VEGF-A SNPs Associated with VEGF-A Mediated Diseases & Conditions

1. A method of treating or reducing the risk of a disease or conditionmediated by VEGF-A in a human, the method comprising administering tosaid human an anti-VEGF-A ligand (eg, an anti-VEGF-A trap, antibody orantibody fragment) that specifically binds to a human VEGF-A that isexpressed by a VEGF-A nucleotide sequence comprising a SNP selected fromthe group consisting of rs699947, rs833061, rs2010963, rs3025039,rs699946, rs2146323, rs1413711, rs833068, rs833069, rs3025000 andrs1570360, wherein said human comprises a VEGF-A nucleotide sequencecomprising said selected SNP.

Herein, specific binding can be tested using a sample VEGF-A using aroutine method known the skilled person, eg, ELISA or SPR (eg, using amethod as described herein). For example, the VEGF-A is provided by asample from said human or another human, eg, a serum or blood sample.

In an example, the ligand comprises an antibody constant region (eg, anantibody Fc region). Optionally, the ligand comprises a human gamma-1heavy chain constant region that comprises an amino acid selected fromthe group consisting of an Asp corresponding to position 204 of SEQ IDNO: 42 and a Leu corresponding to position 206 of SEQ ID NO: 42 andwherein said human comprises an IGHG1*01 human heavy chain constantregion gene segment, or the human expresses antibodies comprising humangamma-1 heavy chain constant regions comprising said selected aminoacid. Optionally, this constant region is comprised by an Fc region ofthe ligand.

In an example, the ligand comprises an anti-VEGF-A binding site thatspecifically binds human VEGF-A. Optionally, the binding site comprisesone or more antibody variable domains or one or more human VEGF-Areceptor domains. In an example, specific binding with a Kd of 1 mm orless (ie, 1 mM or stronger binding), eg, 1 nM or less; or 100 pM orless; or 10 pM or less. Specific binding can be determined, for example,by assessing binding of the ligand to VEGF-A in a sample from said humanor another human comprising said VEGF-A. In an example, the samplecomprises serum, blood, faeces, tissue, a cell, urine and/or saliva ofsaid human.

Optionally, the VEGF-A is a VEGF-A-165 isoform.

In an example, the ligand is an anti-VEGF-A trap, eg, aflibercept. In anexample, the ligand is EYLEA™

In an example, the ligand is an anti-VEGF-A antibody or antibodyfragment, eg, ESBA1008, bevacizumab or ranizumab. In an example, theligand is AVASTIN™ or LUCENTIS™.

In an example, the ligand is an anti-VEGF ankyrin repeat protein(DARPin), eg, abicipar pegol.

In an example, the ligand is an NCE (so-called New Chemical Entity inthe art), eg, sunitinib.

In an example, the condition is selected from the group consisting ofangiogenesis, neovascularisation, ocular vascularisation and solidtumour vascularisation.

In an example, the condition is subretinal neovascularisation.

In an example, the disease or condition is an angiogenic disease orcondition.

Optionally the disease or condition is an angiogenic ocular condition orangiogenic cancer, eg a solid tumour, a gastrointestinal cancer,colorectal cancer, liver cancer, breast cancer, ovarian cancer, nonsmall cell lung cancer, thyroid cancer, an oral cancer, or anhaematological cancer.

Optionally the angiogenic disease or condition is selected from thegroup consisting of psoriasis, rheumatoid arthritis, a hemangioma, anangiofibroma, diabetic retinopathy, corneal neovacularisation andneovascular glaucoma.

Optionally the disease or condition is or comprises vascularpermeability (eg, ocular vascular permeability), edema or inflammationin said human.

For example, the disease or condition is selected from the groupconsisting of brain edema (eg, edema associated with brain injury,stroke or brain tumour); edema associated with an inflammatory disorder(eg, associated with psoriasis or arthritis, rheumatoid arthritis orasthma); edema associated with burns; ascites or pleural effusion (eg,associated with tumours, inflammation or trauma); chronic airwayinflammation; capillary leak syndrome; sepsis; kidney disease (eg,associated with increased leakage of protein); and an eye disorder (eg,age related macular degeneration or diabetic retinopathy).

In an example the method is for reducing or reducing the risk of VEGF-Amediated endothelial cell maintenance or proliferation in an angiogenicdisease or condition in said human.

In an example, the angiogenic disease or condition is an angiogenicdisease or condition recited above, eg, an angiogenic ocular condition.

In an example the method is for regressing neovascularisation in aVEGF-A mediated disease or condition in said human.

In an example the method is for treating or reducing the risk ofneovascularisation in a human, wherein the human has VEGF-Aligand-refractory neovascularisation.

In an example, the human has been diagnosed with said disease orcondition before said administration of the ligand.

For example, the human is partially or completely resistant to treatmentwith an anti-VEGF-A ligand, eg, aflibercept, sunitinib, bevacizumab orranizumab.

In an example, the ligand is administered by intravenous or subcutaneousadministration and/or is comprised in an injectable preparation.

2. The method of concept 1, wherein the condition is an ocularcondition, eg, diabetic retinopathy or retinopathy of prematurity.

In an example, the condition is diabetic retinopathy (DR).

In an example, the condition is age-related macular degeneration (AMD),eg, exudative AMD.

In an example, the condition is polypoidal choroidal vasculopathy (PCV).

In an example, the condition is retinal angiomatous proliferation (RAP).

In an example, the condition is diabetic macular edema (DME).

In an example, the condition is retinal-vein occlusion (RVO).

In an example, the condition is retinopathy of prematurity (ROP).

In an alternative, instead of “a method of treating or reducing the riskof a disease or condition mediated by VEGF-A in a human”, the inventionrelates to “a method of improving visual acuity in a human”

3. The method of concept 1 or 2, wherein the SNP is selected from thegroup consisting of rs699947, rs833061, rs2010963, rs3025039 andrs699946.

In an example, the SNP is rs699947 and optionally the condition is DR.

In an example, the SNP is rs833061 and optionally the condition is DR.

In an example, the SNP is rs2010963 and optionally the condition is DR.

In an example, the SNP is rs3025039 and optionally the condition is DR.

In an example, the SNP is rs699946 and optionally the condition is DR.

4. The method of concept 1 or 2, wherein the SNP is selected from thegroup consisting of rs699947, rs2146323, rs1413711, rs699946, rs833068,rs833069 and rs3025000.

As shown in Table 19, these SNPs are associated with improved ocularresponses following ocular treatment (eg, photodynamic therapy (PDT) orVEGF-A antagonism).

In an example, the SNP is rs699947, eg, homozygous for said SNP.

In an example, the SNP is rs2146323, eg, homozygous for said SNP.

In an example, the SNP is rs1413711, eg, homozygous for said SNP.

In an example, the SNP is rs699946, eg, homozygous for said SNP.

In an example, the SNP is rs833068, eg, homozygous for said SNP.

In an example, the SNP is rs833069, eg, homozygous for said SNP.

In an example, the SNP is rs3025000, eg, homozygous for said SNP.

5. The method of concept 3 or 4, wherein the human is homozygous forsaid SNP.

In another example, the human is heterozygous for said SNP.

6. The method of any one of concepts 2 to 5, wherein the method furthercomprises treating the human with photodynamic therapy.

For example, the method further comprises treating the human with PDTsimultaneously with, or after, administration of said ligand to thehuman.

7. The method of concept 1, wherein the disease or condition is acancer.

8. The method of concept 7, wherein the SNP is rs699947 or rs1570360.

In an example, the SNP is rs699947, eg, homozygous for said SNP.

In an example, the SNP is rs1570360, eg, homozygous for said SNP.

9. The method of any preceding concept, wherein the human comprises (a)a HTRA1 nucleotide sequence comprising SNP rs11200638; (b) an ARMS2nucleotide sequence comprising SNP rs10490924; (c) a CFH nucleotidesequence comprising SNP rs800292, a T at the position of rs1061170 or anA at the position of rs3766404; (d) a complement component 2 (C2)nucleotide sequence comprising SNP rs547154; (e) a prothrombinnucleotide sequence comprising SNP rs1799963; (f) a MTHFR nucleotidesequence comprising SNP rs1801133; (g) a Factor V nucleotide sequencecomprising SNP rs6025; or (h) a VEGFR2 nucleotide sequence comprisingSNP rs4576072 or rs6828477.

In an example the human comprises a HTRA1 nucleotide sequence comprisingSNP rs11200638, eg, in homozygous form.

In an example the human comprises an ARMS2 nucleotide sequencecomprising SNP rs10490924, eg, in homozygous form.

In an example the human comprises a CFH nucleotide sequence comprisingSNP rs800292, eg, in homozygous form.

In an example the human comprises a CFH nucleotide sequence comprisingSNP rs1061170, eg, in homozygous form.

In an example the human comprises a CFH nucleotide sequence comprisingSNP rs3766404, eg, in homozygous form.

In an example the human comprises a complement component 2 (C2)nucleotide sequence comprising SNP rs547154, eg, in homozygous form.

In an example the human comprises a prothrombin nucleotide sequencecomprising SNP rs1799963, eg, in homozygous form.

In an example the human comprises a MTHFR nucleotide sequence comprisingSNP rs1801133, eg, in homozygous form.

In an example the human comprises a Factor V nucleotide sequencecomprising SNP rs6025, eg, in homozygous form.

In an example the human comprises a VEGFR2 nucleotide sequencecomprising SNP rs4576072, eg, in homozygous form.

In an example the human comprises a VEGFR2 nucleotide sequencecomprising SNP rs6828477, eg, in homozygous form.

10. The method of any one of concepts 2 to 6, wherein the humancomprises (a) a HTRA1 nucleotide sequence comprising SNP rs11200638; (b)an ARMS2 nucleotide sequence comprising SNP rs10490924; (c) a CFHnucleotide sequence comprising SNP rs800292; or (d) a complementcomponent 2 (C2) nucleotide sequence comprising SNP rs547154.

These SNPs are risk factors for ocular conditions.

In an example, the ocular condition is DR or ROP and the method is fortreating or reducing the risk of DR or ROP.

11. The method of any one of concepts 2 to 6, wherein the humancomprises (i) an ARMS2 nucleotide sequence comprising a G at theposition of SNP rs10490924; (ii) a CFH nucleotide sequence comprising aT at the position of SNP rs1061170 or rs3766404; (iii) a prothrombinnucleotide sequence comprising SNP rs1799963; (iv) a MTHFR nucleotidesequence comprising SNP rs1801133; (v) a Factor V nucleotide sequencecomprising SNP rs6025; or (vi) a VEGFR2 nucleotide sequence comprisingSNP rs4576072 or rs6828477.

These SNPs are associated with improved responses following treatment(eg, PDT and/or VEGF-A antagonism) of an ocular disease or condition.

In an example, the ocular condition is DR and the method is for treatingor reducing the risk of DR.

SNPs Associated with Improved Responses Following Anti-VEGF-A Treatmentof an Ocular Disease or Condition

12. A method of treating or reducing the risk of a disease or conditionmediated by VEGF-A in a human, the method comprising administering tosaid human an anti-VEGF-A ligand (eg, an anti-VEGF-A trap, antibody orantibody fragment) that specifically binds to a human VEGF-A, whereinthe human comprises (i) an ARMS2 nucleotide sequence comprising a G atthe position of SNP rs 10490924; (ii) a CFH nucleotide sequencecomprising a T at the position of SNP rs1061170 or an T at the positionof rs3766404; or (iii) a VEGFR2 nucleotide sequence comprising SNPrs4576072 or rs6828477, wherein the ligand comprises a human gamma-1heavy chain constant region that comprises an amino acid selected fromthe group consisting of an Asp corresponding to position 204 of SEQ IDNO: 42 and a Leu corresponding to position 206 of SEQ ID NO: 42 andwherein said human comprises an IGHG1*01 human heavy chain constantregion gene segment, or the human expresses antibodies comprising humangamma-1 heavy chain constant regions comprising said selected aminoacid.

These SNPs are associated with improved responses following anti-VEGF-Atreatment of an ocular disease or condition.

In an example, the ocular condition is DR and the method is for treatingor reducing the risk of DR.

In an example the human comprises an ARMS2 nucleotide sequencecomprising G at the position of SNP rs10490924, eg, in homozygous form.

In an example the human comprises a CFH nucleotide sequence comprising aT at the position of SNP rs1061170, eg, in homozygous form.

In an example the human comprises a CFH nucleotide sequence comprising aT at the position of SNP rs3766404, eg, in homozygous form.

In an example the human comprises a VEGFR2 nucleotide sequencecomprising SNP rs4576072, eg, in homozygous form.

In an example the human comprises a VEGFR2 nucleotide sequencecomprising SNP rs6828477, eg, in homozygous form. 13. The method ofconcept 12, wherein the condition is an ocular condition, eg, diabeticretinopathy or retinopathy of prematurity.

In an example, the condition is diabetic retinopathy (DR).

In an example, the condition is age-related macular degeneration (AMD),eg, exudative AMD.

In an example, the condition is polypoidal choroidal vasculopathy (PCV).

In an example, the condition is retinal angiomatous proliferation (RAP).

In an example, the condition is diabetic macular edema (DME).

In an example, the condition is retinal-vein occlusion (RVO).

In an example, the condition is retinopathy of prematurity (ROP).

In an alternative, instead of “a method of treating or reducing the riskof a disease or condition mediated by VEGF-A in a human”, the inventionrelates to “a method of improving visual acuity in a human”

14. The method of concept 12 or 13, wherein the human further comprisesa VEGF-A SNP selected from the group consisting of rs699947, rs833061,rs2010963, rs3025039 and rs699946.

In an example, the SNP is rs699947.

In an example, the SNP is rs833061.

In an example, the SNP is rs2010963.

In an example, the SNP is rs3025039.

In an example, the SNP is rs699946.

15. The method of any one of concepts 12 to 14, wherein the methodfurther comprises treating the human with photodynamic therapy.

For example, the method further comprises treating the human with PDTsimultaneously with, or after, administration of said ligand to thehuman.

16. The method of concept 12, wherein the disease or condition is acancer.

17. The method of concept 16, wherein the human further comprises VEGF-ASNP rs699947 or rs1570360.

In an example, the SNP is rs699947, eg, homozygous for said SNP.

In an example, the SNP is rs1570360, eg, homozygous for said SNP.

Antagonism of VEGF-A & PDGF-B Pathways

PDGF-B is also known as IBGC5, PDGF-2, PDGF2, SIS, SSV and c-sis.Platelet-derived growth factor receptor beta (PDGFRB) is also known asCD140B, IBGC4, IMF1, JTK12, PDGFR-1 and PDGFR1.

PDGF is a growth factor which may play a role in ocularneovascularization, and has been documented to be a mitogen forpericytes, as well as smooth muscles cells, fibroblasts, and othermesenchymal cell types. Pericytes appear critical for the maintenance ofestablished blood vessels and may be important in the maturation processin ocular conditions, such as choroidal neovascularization. It has beenhypothesized that there is a period of VEGF dependency of endothelialcells that overlaps with a period of responsiveness to PDGF withdrawalin newly formed neovascular vessels. Established mature vessels may beassociated with resistance to anti-VEGF blockade or rapid recurrence ofchoroidal neovascularization.

PDGF has been demonstrated to stimulate angiogenesis and pericyterecruitment. Loss of pericytes in retinal vessels is thought to beassociated with abnormalities of the vasculature and instability,including the formation of microaneurysms and vascular permeability.Loss of pericytes with PDGF-blockade may be associated with regressionof maturing neovascularization. Pericytes produce VEGF-A under selectedconditions, possibly thereby protecting endothelial cells whengeneralized suppression of VEGF-A is present.

Reference is made to Am J Pathol. 2006 June; 168(6):2036-53; “Inhibitionof platelet-derived growth factor B signaling enhances the efficacy ofanti-vascular endothelial growth factor therapy in multiple models ofocular neovascularisation”; Jo N et al. Jo et al demonstrated increasedsuppression of neovascularization in experimental models with specificblockade of both VEGF-A and PDGF-B as compared with blockade with VEGF-Aalone. In addition, neovascularization became more resistant to VEGF-Ablockade with progression. Suppression of VEGF-A and PDGF-B togethercaused regression of neovascularization not responsive to anti-VEGF-Aalone.

Reference is also made to:—

-   Angiogenesis. 2014 July; 17(3):553-62. doi:    10.1007/s10456-013-9402-5. Epub 2013 Oct. 24; “Antagonism of PDGF-BB    suppresses subretinal neovascularization and”; enhances the effects    of blocking VEGF-A2; Dong A et al-   MAbs. 2010 January-February; 2(1):20-34. Epub 2010 Jan. 2; “A    dual-targeting PDGFRbeta/VEGF-A molecule assembled from stable    antibody fragments demonstrates anti-angiogenic activity in vitro    and in vivo”; Mabry R et al.

A treatment regimen combining inhibition of pericyte and endothelialcell function through the use of concomitant administration ofanti-VEGF-A targeting and PDGF-BB pathway targeting is useful forblocking both paracrine and autocrine VEGF signalling in endothelialcells.

Thus, this aspect of the invention provides the following.

18. The method of any preceding concept, wherein the method furthercomprises antagonising PDGF-B in said human.

In an example of any aspect herein, the method comprises administeringREGN2176-3 (Regeneron Pharmaceuticals, Inc) to the human. REGN2176-3comprises aflibercept.

19. The method of concept 18, wherein the method comprises administeringan anti-PDGF-B ligand to the human simultaneously or sequentially withthe anti-VEGF-A ligand.

In an example, the anti-VEGF-A and anti-PDGF-B ligands are comprisedtogether by a pharmaceutical formulation that is administered to thehuman. In an example of any aspect herein, the method comprisesadministering REGN2176-3 (Regeneron Pharmaceuticals, Inc) to the human.

In an example a bispecific ligand (eg, trap or antibody or antibodyfragment) is administered, wherein the ligand comprises a human VEGF-Abinding site and a huan PDGF-B binding site.

In an example, the anti-PDGF-B ligand antagonises a human PDGF-B encodedby said PDGF-B nucleotide sequence of (i).

In an example, the anti-PDGF-B ligand comprises or consists of ananti-PDGF-B antibody or fragment, an anti-PDGF-B trap, an anti-PDGF-Baptamer (eg, E10030 or FOVISTA™) or an anti-PDGF-B NCE (so-called NewChemical Entity in the art).

Examples of suitable anti-PDGF-B pathway antibodies and variable regionsfor incorporation into antibodies for use in the invention are disclosedin WO 2014109999A1, the disclosure of which, and specifically includingthe sequences therein of such antibodies and variable regions, as wellas methods of testing and medical diseases and conditions for use (whichare suitable for the present invention), are incorporated herein asthough explicitly written herein and to provide disclosure of featuresthat can be incorporated into concepts herein.

In an example herein, the anti-PDGF-B ligand specifically binds to humanPDGF-B dimer (ie, so-called PDGF-BB).

20. The method of concept 18, wherein the method comprises administeringan anti-PDGFR-B ligand to the human simultaneously or sequentially withthe anti-VEGF-A ligand.

In an example, the anti-VEGF-A and anti-PDGFR-B ligands are comprisedtogether by a pharmaceutical formulation that is administered to thehuman. In an example a bispecific ligand (eg, trap or antibody orantibody fragment) is administered, wherein the ligand comprises a humanVEGF-A binding site and a human PDGFR-B binding site. Reference is madeto Dong et al, which describes a suitable example.

In an example, the PDGFR-B ligand antagonises a human PDGFR-B encoded bysaid PDGF-B nucleotide sequence of (ii).

In an example herein, the anti-PDGFRB antagonises binding of thereceptor to human PDGF-B dimer (ie, so-called PDGF-BB), eg, wherein thePDGF-B is encoded by a nucleotide sequence of (i).

Suitable PDGFRβ-specific inhibitors are disclosed in WO2008130704, forexample, the disclosure and sequences of which are incorporated hereinby reference.

21. The method of any preceding concept, wherein the human has receiveda human PDGF-B or PDGFR-B antagonist prior to administering saidanti-VEGF-A ligand.

Antagonism of VEGF-A & Angiopoietin-2 Pathways

The angiopoietins are ligands for the endothelial cell receptor Tie2 andare essential for vascular development and angiogenesis. Unlike otherfamily members, angiopoietin-2 (Ang2) is strongly up-regulated byendothelial cells at sites of angiogenesis and vascular remodelling,including tumours. Enhanced anti-tumour effects have been observed inpreclinical models with combined blockade of both VEGF and Ang2.

The Ang2 pathway acts to remodel blood vessels and, in particular, isactive during both developmental and pathological angiogenesis. But, itis nearly absent from mature, quiescent vasculature. Hence a combinationAng2/VEGF blockade results in decreased survival and maturation ofneovessels as well as inhibition of pathological leaks. Ang2 inhibitionalso blocks vascular remodelling driven by inflammation in model systemsin which VEGF inhibition is ineffective, suggesting that combinationblockade has potential for a greater therapeutic benefit.

The invention thus further provides:—

22. The method of any one of concepts 1 to 17, comprising antagonisingangiopoietin-2 (Ang2) in said human.

In an example, the method comprises administering nesvacumab (RegeneronPharmaceuticals, Inc) to the human.

23. The method of concept 22, wherein the method comprises administeringan anti-Ang2 ligand (eg, nesvacumab) to the human simultaneously orsequentially with the anti-VEGF-A ligand.

In an example, the anti-Ang2 ligand comprises or consists of ananti-Ang2 antibody or fragment, an anti-Ang2 trap, an anti-Ang2 aptameror an anti-Ang2 NCE (so-called New Chemical Entity in the art).

24. The method of concept 22, wherein an anti-Ang2 receptor (eg,anti-human Tie2) ligand is administered to the human simultaneously orsequentially with the anti-VEGF-A ligand.

25. The method of any one of concepts 1 to 24, wherein the human hasreceived a human Ang2 or Ang2 receptor (eg, Tie2) antagonist prior toadministering said anti-VEGF-A ligand.

26. The method of any preceding concept, wherein the anti-VEGF-A ligand(eg, an anti-VEGF-A antibody, antibody fragment or VEGF-A trap)comprises a human gamma-1 heavy chain constant region that comprises anamino acid selected from the group consisting of an Asp corresponding toposition 204 of SEQ ID NO: 42 and a Leu corresponding to position 206 ofSEQ ID NO: 42; and wherein said human comprises an IGHG1*01 human heavychain constant region gene segment, or the human expresses antibodiescomprising human gamma-1 heavy chain constant regions comprising saidselected amino acid.

Optionally, this constant region is comprised by an Fc region of theligand.

In one embodiment, the ligand of the invention is a VEGF-A trapcomprising the polypeptide of SEQ ID NO: 127, eg, comprising orconsisting of the polypeptide of SEQ ID NO: 127.

27. The method of any one of concepts 1 to 25, wherein the anti-VEGF-Aligand (eg, an anti-VEGF-A antibody, antibody fragment or VEGF-A trap)comprises a human gamma-2 heavy chain constant region that comprises anamino acid selected from the group consisting of a Pro corresponding toposition 72 of SEQ ID NO: 44, an Asn corresponding to position 75 of SEQID NO: 44, a Phe corresponding to position 76 of SEQ ID NO: 44, a Valcorresponding to position 161 of SEQ ID NO: 44 and an Ala correspondingto position 257 of SEQ ID NO: 44 and wherein said human comprises anIGHG2*01 human heavy chain constant region gene segment, or the humanexpresses antibodies comprising human gamma-2 heavy chain constantregions comprising said selected amino acid.

Optionally, this constant region is comprised by an Fc region of theligand.

For example, the ligand is a VEGF-A trap comprising one or more humanVEGF-A receptor domain sequences fused to a human gamma-1 or -2 heavychain constant region, eg, a constant region as defined in concept 26 or27. In an example, such a trap comprises first and second (eg, comprisesonly two species of) VEGF-A receptor domain sequences, eg, first andsecond human Flt1 domain sequences; or first and second human KDR domainsequences; or a Flt domain sequence and a KDR domain sequence. In anexample, the trap comprises a dimer of the following polypeptide (N- toC-terminally): a human Flt1 Ig-like C2-type 2 domain sequence and ahuman KDR Ig-like C2-type 3 domain sequence fused to the human gamma-1heavy chain constant region of concept 26 or human gamma-2 heavy chainconstant region of concept 27. In an example, the constant regions arepart of antibody Fc regions.

A suitable human Flt1 Ig-like C2-type 2 domain sequence for use in thepresent invention is shown in SEQ ID NO: 129. A suitable human KDRIg-like C2-type 3 domain sequence for use in the present invention isshown in SEQ ID NO: 130.

28. The method of any one of concepts 1 to 27, wherein the anti-VEGF-Aligand is a human anti-VEGF-A antibody, antibody fragment or VEGF-Atrap.

29. The method of any preceding concept, comprising, before saidadministering, selecting a human comprising said VEGF-A, HTRA1, ARMS2,CFH, C2, MTHFR, prothrombin, factor V or VEGFR2 SNP, wherein the humanis the human of concept 1 or 12.

30. The method of any one of concepts 1 to 28, wherein the human hasbeen determined to comprise said VEGF-A, HTRA1, ARMS2, CFH, C2, MTHFR,prothrombin, factor V or VEGFR2 SNP.

31. The method of any one of concepts 1 to 28, comprising the step ofdetermining that the human comprises said VEGF-A, HTRA1, ARMS2, CFH, C2,MTHFR, prothrombin, factor V or VEGFR2 SNP, optionally, wherein thedetermining step is performed before administration of the ligand to thehuman.32. The method of concept 31, wherein the step of determining comprisesassaying a biological sample from the human for said VEGF-A, HTRA1,ARMS2, CFH, C2, MTHFR, prothrombin, factor V or VEGFR2 SNP.33. The method of concept 32, wherein the assaying comprises nucleicacid amplification and optionally one or more methods selected fromsequencing, next generation sequencing, nucleic acid hybridization, andallele-specific amplification and/or wherein the assaying is performedin a multiplex format.34. An anti-VEGF-A ligand (eg, an anti-VEGF-A antibody, antibodyfragment or VEGF-A trap) for use in a method of any one of concepts 1 to33.35. The ligand of concept 34, wherein the anti-VEGF-A ligand is a humananti-VEGF-A antibody, antibody fragment or VEGF-A trap (eg,aflibercept).36. The ligand of concept 34 or 35, wherein said ligand is administeredby intravenous or subcutaneous administration and/or is comprised in aninjectable preparation.

C2 SNP rs547154 is indicated in the 1000 Genomes database as having anaverage cumulative allele frequency of 10% across all human populations;a frequency for the AFR population of 15% and above average also for thefollowing human populations: PUR, IBS, GBR, ASW, LWK, YRI. Thus, whenthe ancestry of the human belongs to one of these populations, the humanmay have an elevated risk of an ocular disease or condition or otherVEGF-A mediated disease or condition and the invention comprisesadministering the ligand to such a human. Thus, in an embodiment, thehuman comprises C2 SNP rs547154 and is of AFR, PUR, IBS, GBR, ASW, LWKor YRI ancestry. For example, the human is of AFR ancestry.

VEGF-A SNP rs1413711 is indicated in the 1000 Genomes database as havingan average cumulative allele frequency of 64% across all humanpopulations; a frequency for the AFR and ASN populations of 80% and 71%respectively, and above average also for the following humanpopulations: ASW, LWK, YRI, PUR, CHB, CHS and JPT. Thus, when theancestry of the human belongs to one of these populations, the human mayhave an improved treatment of an ocular disease or condition and theinvention comprises administering the ligand to such a human. Thus, inan embodiment, the human comprises VEGF-A SNP rs1413711 (eg, inhomozygous form) and is of AFR, ASN, ASW, LWK, YRI, PUR, CHB, CHS or JPTancestry. For example, the human is of AFR ancestry. For example, thehuman is of ASN ancestry. In an example, the method is for improvingvisual acuity in said human.

VEGF-A SNP rs699946 is indicated in the 1000 Genomes database as havingan average cumulative allele frequency of 26% across all humanpopulations; a frequency for the ASN population of 42%, and aboveaverage also for the following human populations: PUR 34%, CHB 45%, CHS41% and JPT 40%. Thus, when the ancestry of the human belongs to one ofthese populations, the human may have an improved treatment of an oculardisease or condition and the invention comprises administering theligand to such a human. Thus, in an embodiment, the human comprisesVEGF-A SNP rs699946 (eg, in homozygous form) and is of ASN, ASW, PUR,CHB, CHS or JPT ancestry. For example, the human is of ASN ancestry. Inan example, the method is for improving visual acuity in said human.

VEGF-A SNP rs3025000 is indicated in the 1000 Genomes database as havingan average cumulative allele frequency of 26% across all humanpopulations; a frequency for the AMR, ASN and EUR populations of 30%,42% and 27% respectively, and above average also for the following humanpopulations: MXL (29%), PUR (38%), CHB (45%), CHS (41%, JPT (40%), CEU(30%), GBR (27%), IBS (39%) and TSI (31%). Thus, when the ancestry ofthe human belongs to one of these populations, the human may have animproved treatment of an ocular disease or condition and the inventioncomprises administering the ligand to such a human. Thus, in anembodiment, the human comprises VEGF-A SNP rs3025000 (eg, in homozygousform) and is of AMR, ASN, EUR, MXL, PUR, CHB, CHS, JPT, CEU, GBR, IBS orTSI ancestry. For example, the human is of AMR ancestry. For example,the human is of ASN ancestry. For example, the human is of EUR ancestry.

Prothrombin SNP rs1799963 is almost exclusively in Caucasians; this SNPis indicated in the 1000 Genomes database as having an above averagecumulative allele frequency in the following human populations: AMR,EUR, TSI, GBR and PUR. Thus, when the ancestry of the human belongs toone of these populations, the human may have an improved treatment of anocular disease or condition and the invention comprises administeringthe ligand to such a human. Thus, in an embodiment, the human comprisesprothrombin SNP rs1799963 (eg, in homozygous form) and is of Caucasian,AMR, EUR, TSI, GBR or PUR ancestry. For example, the human is ofCaucasian ancestry. For example, the human is of EUR ancestry. In anexample, the condition is CNV.

MTHFR SNP rs1801133 is indicated in the 1000 Genomes database as havingan above average cumulative allele frequency in the following humanpopulations: AMR, ASN, EUR, CHB, CLM, IBS, JPT, MXL, PUR and TSI. Thus,when the ancestry of the human belongs to one of these populations, thehuman may have an improved treatment of an ocular disease or conditionand the invention comprises administering the ligand to such a human.Thus, in an embodiment, the human comprises MTHFR SNP rs1801133 (eg, inhomozygous form) and is of AMR, ASN, EUR, CHB, CLM, IBS, JPT, MXL, PURor TSI ancestry. For example, the human is of Caucasian ancestry. Forexample, the human is of AMR ancestry. For example, the human is of ASNancestry. For example, the human is of EUR ancestry. For example, thehuman is of EUR ancestry. In an example, the condition is CNV.

VEGFR2 SNP rs4576072 is indicated in the 1000 Genomes database as havingan average cumulative allele frequency of 8% across all humanpopulations; a frequency for the AMR and EUR populations of 10% and 11%respectively, and above average also for the following humanpopulations: PUR (14%), CEU (9%), GBR (13%) and TSI (13%). Thus, whenthe ancestry of the human belongs to one of these populations, the humanmay have an improved treatment of an ocular disease or condition and theinvention comprises administering the ligand to such a human. Thus, inan embodiment, the human comprises VEGFR2 SNP rs4576072 (eg, inhomozygous form) and is of AMR, EUR, PUR, CEU, GBR or TSI ancestry. Forexample, the human is of AMR ancestry. For example, the human is of EURancestry. In an embodiment 3 or 4 VEGFR2 SNPs from rs4576072 andrs6828477 provide for improved treatment. Thus, for example, the humancomprises 3 or 4 copies of VEGFR2 SNPs selected from rs4576072 andrs6828477, eg, the human comprise GG (ie, the human comprises VEGFR2 SNPrs4576072 in homozygous form) and AA or AG (ie, the human comprisesVEGFR2 SNP rs6828477, eg, in homozygous form); or GA (rs4576072) andAA(rs6828477).

Administering Human VEGF-A Ligands to Humans Comprising PDFG-B PathwaySNP Risk Factors

Endothelial cells (ECs) in blood vessels under formation are stabilizedby the recruitment of pericytes, both in normal tissues and duringangiogenesis in pathologic situations, including cancer. Endothelialcells in small blood vessels and capillaries interact with pericytes,cells of mesenchymal origin that provide important support for bloodvessel formation and function. Numerous studies describe thesignificance of members of the platelet-derived growth factor (PDGF)family for recruitment to and productive association of pericytes withthe blood vessel endothelium during embryonal development. Strikingly,mice lacking components of the PDGF-B/PDGFR-β signaling axis areessentially devoid of pericytes, and as a consequence die frommicrohemorrhaging because of malformed blood vessels. Reference is madeto Blood. 2011 September 8; 118(10): 2906-2917, prepublished online 2011July 21, doi: 10.1182/blood-2011-01-331694, “Pericytes promoteendothelial cell survival through induction of autocrine VEGF-Asignaling and Bcl-w expression”, Franco M et al. The authors describethat newly formed vascular sprouts recruit pericytes primarily throughsecretion of platelet derived growth factor beta (PDGF-BB) byendothelial tip cells. Pericytes respond by migrating along thematrix-retained gradient of PDGF-BB, and by a proliferative burst asthey reach the tip of the sprout. Reciprocally, pericytes up-regulateexpression of cell-bound VEGF-A as they mature and are recruited intonewly formed vessels. The authors found that pericytes, in addition toproducing VEGF-A that acts in a paracrine fashion, stimulate autocrineexpression of VEGF-A by tumour endothelial cells. The authors suggestthat a treatment regimen combining inhibition of pericyte andendothelial cell function through the use of concomitant administrationof a VEGF-targeting antibody and a PDGF-BB/PDGFRβ-targeting antibody forblocking both paracrine and autocrine VEGF signalling in ECs.

The invention thus provides the following aspects:—

-   1. A method of treating or reducing the risk of a VEGF-A mediated    disease or condition in a human, the method comprising administering    an anti-human VEGF-A ligand; an an anti-human PDGF-B ligand or an    anti-PDGFR-B ligand to a human, wherein the human comprises (i) a    PDGF-B nucleotide sequence comprising a SNP selected from the group    consisting of rs142404523 (ie, a C corresponding to position −776)    and a C at the position of rs1800818 (ie, a C corresponding to    position −735); or (ii) a PDGFR-B nucleotide sequence comprising a    SNP selected from the group consisting of rs246395 (ie, a G    corresponding to position 2601) and rs74943037 (ie, a T    corresponding to position 1391).

A suitable example of an anti-VEGF-A ligand, which is an antagonist ofhuman VEGF-A, is aflibercept, sunitinib, ESBA1008, bevacizumab orranizumab. In an example, the ligand comprises or consists of ananti-VEGF-A antibody or fragment (eg, ESBA1008, bevacizumab orranizumab), an anti-VEGF-A trap (eg, VEGF-A receptor binding sites fusedto antibody Fc regions, eg, aflibercept), an aptamer or an NCE(so-called New Chemical Entity in the art, eg, sunitinib).

In an example of any aspect herein, the method comprises administeringREGN2176-3 (Regeneron Pharmaceuticals, Inc) to the human. REGN2176-3comprises aflibercept and an anti-PDGF-B ligand.

In an embodiment, said selected SNP (eg, rs246395) is associated withVEGF-A secretion from pericytes in said human, for example maintained orincreased VEGF-A secretion from pericytes in said human (eg, ocularpericytes or pericytes at the site of a solid tumour in said patient).Thus, administration of an anti-VEGF-A ligand would be beneficial toalso target such secreted VEGF-A. This is useful, for example, when thedisease or condition is angiogenesis or neovascularisation or associatedwith one or both of these.

For PDGF-B, a C at the position of rs1800818 (ie, −735C) is indicated inthe 1000 Genomes database as having an average cumulative allelefrequency of 37% across all human populations; a frequency for the AFRand EUR populations of 62% and 41% respectively (ie, above average) andalso above average for the following human populations: ASW 60%, LWK58%, YRI 68%, CEU 46%, FIN 46%, IBS 50% and TSI 38%. Thus, when theancestry of the human belongs to one of these populations, the human mayhave an elevated risk of angiogenesis or other VEGF-A mediated diseaseor condition and the invention comprises administering the ligand such ahuman. Thus, in an embodiment, the human comprises a PDGF-B nucleotidesequence comprising −735C, ie, a C at the position of PDGF-B SNPrs1800818 and wherein the human is of AFR, EUR, ASW, LWK, YRI, CEU, FIN,IBS or TSI ancestry. For example, the human is of AFR ancestry. Forexample, the human is of EUR ancestry.

For PDGF-B, SNP rs142404523 (−776T>C) is indicated in the 1000 Genomesdatabase as having an average cumulative allele frequency of 8% acrossall human populations; a frequency for the AFR and EUR populations of17% and 10% respectively (ie, above average) and also above average forthe following human populations: ASW 16%, LWK 18%, YRI 16%, PUR 11%, CEU11%, FIN 9%, GBR 12% and IBS 18%. Thus, when the ancestry of the humanbelongs to one of these populations, the human may have an elevated riskof angiogenesis or other VEGF-A mediated disease or condition and theinvention comprises administering the ligand such a human. Thus, in anembodiment, the human comprises PDGF-B SNP rs142404523 and is of AFR,EUR, ASW, LWK, YRI, PUR, CEU, FIN, GBR or IBS ancestry. For example, thehuman is of AFR ancestry. For example, the human is of EUR ancestry.

For PDGFR-B, SNP rs246395 (2601A>G) the 1000 Genomes database indicatesan average cumulative allele frequency of 23% for G across all humanpopulations; a frequency for the AMR and EUR populations of 29% and 30%respectively (ie, above average) and also above average for thefollowing human populations: CLM (36%), MXL (25%), PUR (26%), CEU (39%),GBR (30%), IBS (29%) and TSI (31%). Thus, when the human belongs to oneof these populations, it may have an elevated risk of angiogenesis orother VEGF-A mediated disease or condition and the invention comprisesadministering the ligand such a human. Thus, in an embodiment, the humancomprises PDGFR-B SNP rs246395 and is of AMR, EUR, CLM, MXL, PUR, CEU,GBR, IBS or TSI ancestry. For example, the human is of AMR ancestry. Forexample, the human is of EUR ancestry.

For PDGFR-B, SNP rs74943037 is indicated in the 1000 Genomes database ashaving an average cumulative allele frequency of 3% for G across allhuman populations; a frequency for the AFR population of 10% (ie, aboveaverage) and also above average for the following human populations: ASW8%, LWK 14% and YRI 8%. Thus, when the ancestry of the human belongs toone of these populations, the human may have an elevated risk ofangiogenesis or other VEGF-A mediated disease or condition and theinvention comprises administering the ligand such a human. Thus, in anembodiment, the human comprises PDGFR-B SNP rs74943037 and is of AFR,ASW, LWK or YRI ancestry. For example, the human is of AFR ancestry.

2. The method of aspect 1, wherein the human is homozygous for saidselected SNP (eg, homozygous for rs246395 or homozygous for a C at theposition of rs1800818 (ie, homozygous for a C corresponding to position−735)).

Such homozygotes may have increased severity or risk of said disease orcondition.

3. The method of aspect 1 or 2, wherein the human comprises a PDGF-Bnucleotide sequence comprising a SNP of (i) and a PDFGR-B nucleotidesequence comprising a SNP of (ii).

For example, the human comprises a C at the position of rs1800818 andrs246395. In another example, the human comprises a C at the position ofrs1800818 and rs74943037.

For example, the human comprises rs142404523 and rs246395. In anotherexample, the human comprises rs142404523 and rs74943037.

4. The method of any one of aspects 1 to 3, wherein the human comprises(a) a VEGF-A nucleotide sequence comprising a SNP selected from thegroup consisting of rs699947, rs833061, rs2010963, rs3025039, rs699946,rs2146323, rs1413711, rs833068, rs833069, rs3025000 and rs1570360; (b) aHTRA1 nucleotide sequence comprising SNP rs11200638; (c) an ARMS2nucleotide sequence comprising SNP rs10490924; (d) a Complement Factor H(CFH) nucleotide sequence comprising SNP rs800292, rs1061170 orrs3766404; (e) a Complement Component 2 (C2) nucleotide sequencecomprising SNP rs547154; (f) a prothrombin nucleotide sequencecomprising SNP rs1799963; (g) a MTHFR nucleotide sequence comprising SNPrs1801133; (h) a Factor V nucleotide sequence comprising SNP rs6025; or(i′) a VEGFR2 nucleotide sequence comprising SNP rs4576072 or rs6828477.

In an example, the human comprises a SNP of (a).

For example, the human comprises rs699947 and optionally the conditionis DR or a solid tumour.

For example, the human comprises rs833061 and optionally the conditionis DR or a solid tumour.

For example, the human comprises rs2010963 and optionally the conditionis DR or a solid tumour.

For example, the human comprises rs3025039 and optionally the conditionis DR or a solid tumour.

For example, the human comprises rs699946 and optionally the conditionis DR or a solid tumour.

For example, the human comprises rs2146323.

For example, the human comprises rs1413711, optionally the human ishomozygous for said SNP.

For example, the human comprises rs833068, optionally the human ishomozygous for said SNP.

For example, the human comprises rs833069, optionally the human ishomozygous for said SNP.

For example, the human comprises rs3025000.

For example, the human comprises rs1570360.

In an example, the human comprises a SNP of (a) and (b). In an example,the human comprises a SNP of (a) and (c). In an example, the humancomprises a SNP of (a) and (d). In an example, the human comprises a SNPof (a) and (e). In an example, the human comprises a SNP of (a) and (f).In an example, the human comprises a SNP of (a) and (g). In an example,the human comprises a SNP of (a) and (h). In an example, the humancomprises a SNP of (a) and (i′).

Optionally in any aspect herein, the ligand specifically binds to orantagonises a VEGF-A, eg, a VEGF-A encoded by a VEGF-A nucleotidesequence comprising a SNP of (a). In one example, this can be determinedby specific binding to or antagonism of VEGF-A in a sample in vitro (eg,serum or blood sample) from the human, wherein the human comprises saidVEGF-A nucleotide sequence. Specific binding can be determined, forexample, by SPR or ELISA as will be known to the skilled person. Theskilled person will also be familiar with standard assays for VEGF-Aantagonism. Additionally, in an example the genome of the humancomprises said SNP of (a).

5. The method of any one of aspects 1 or 4, wherein the human comprisesa human VEGF-A nucleotide sequence comprising a SNP selected from thegroup consisting of rs699947, rs833061, rs2010963, rs3025039, rs699946,rs2146323, rs1413711, rs833068, rs833069, rs3025000 and rs1570360 andthe ligand antagonises a VEGF-A encoded by said nucleotide sequence.

In an example of any aspect herein, the VEGF-A is VEGF-A-(165) isoform.

6. The method of any one of aspects 1 to 5, wherein the method furthercomprises antagonising PDGF-B in said human.

In an example of any aspect herein, the method comprises administeringREGN2176-3 (Regeneron Pharmaceuticals, Inc) to the human. REGN2176-3comprises aflibercept.

7. The method of aspect 6, wherein the method comprises administering ananti-PDGF-B ligand to the human simultaneously or sequentially with theanti-VEGF-A ligand.

In an example, the anti-VEGF-A and anti-PDGF-B ligands are comprisedtogether by a pharmaceutical formulation that is administered to thehuman. In an example of any aspect herein, the method comprisesadministering REGN2176-3 (Regeneron Pharmaceuticals, Inc) to the human.

In an example, the anti-PDGF-B ligand antagonises a human PDGF-B encodedby said PDGF-B nucleotide sequence of (i).

In an example, the anti-PDGF-B ligand comprises or consists of ananti-PDGF-B antibody or fragment, an anti-PDGF-B trap, an anti-PDGF-Baptamer (eg, E10030 (FOVISTA™), described in, e.g., U.S. Pat. Nos.6,207,816; 5,731,144; 5,731,424; and 6,124,449; each of which isincorporated by reference herein in its entirety) or an anti-PDGF-B NCE(so-called New Chemical Entity in the art).

Examples of suitable anti-PDGF-B pathway antibodies and variable regionsfor incorporation into antibodies for use in the invention are disclosedin WO2014109999A1, the disclosure of which, and specifically includingthe sequences therein of such antibodies and variable regions, as wellas methods of testing and medical diseases and conditions for use (whichare suitable for the present invention), are incorporated herein asthough explicitly written herein and to provide disclosure of featuresthat can be incorporated into aspects herein.

In an example herein, the anti-PDGF-B ligand specifically binds to humanPDGF-B dimer (ie, so-called PDGF-BB).

8. The method of aspect 6, wherein the method comprises administering ananti-PDGFR-B ligand to the human simultaneously or sequentially with theanti-VEGF-A ligand.

In an example, the anti-VEGF-A and anti-PDGFR-B ligands are comprisedtogether by a pharmaceutical formulation that is administered to thehuman.

In an example, the PDGFR-B ligand antagonises a human PDGFR-B encoded bysaid PDGF-B nucleotide sequence of (ii).

In an example herein, the anti-PDGFRB antagonises binding of thereceptor to human PDGF-B dimer (ie, so-called PDGF-BB), eg, wherein thePDGF-B is encoded by a nucleotide sequence of (i).

Suitable PDGFRβ-specific inhibitors are disclosed in WO2008130704, forexample, the disclosure and sequences of which are incorporated hereinby reference.

9. The method of any one of aspects 1 to 8, wherein the human hasreceived a human PDGF-B or PDGFR-B antagonist prior to administeringsaid anti-VEGF-A ligand.

10. The method of any one of aspects 1 to 9, wherein the condition isselected from the group consisting of angiogenesis, neovascularisation,ocular vascularisation and solid tumour vascularisation.

In an example, the condition is subretinal neovascularisation.

11. The method of any one of aspects 1 to 9, wherein the disease orcondition is an angiogenic disease or condition.

Optionally the disease or condition is an angiogenic ocular condition orangiogenic cancer, eg a solid tumour, a gastrointestinal cancer,colorectal cancer, liver cancer, breast cancer, ovarian cancer, nonsmall cell lung cancer, thyroid cancer, an oral cancer, or anhaematological cancer.

Optionally the angiogenic disease or condition is selected from thegroup consisting of psoriasis, rheumatoid arthritis, a hemangioma, anangiofibroma, diabetic retinopathy, corneal neovacularisation andneovascular glaucoma.

12. The method of any one of aspects 1 to 11, wherein the disease orcondition is or comprises vascular permeability (eg, ocular vascularpermeability), edema or inflammation in said human.

For example, the disease or condition is selected from the groupconsisting of brain edema (eg, edema associated with brain injury,stroke or brain tumour); edema associated with an inflammatory disorder(eg, associated with psoriasis or arthritis, rheumatoid arthritis orasthma); edema associated with burns; ascites or pleural effusion (eg,associated with tumours, inflammation or trauma); chronic airwayinflammation; capillary leak syndrome; sepsis; kidney disease (eg,associated with increased leakage of protein); and an eye disorder (eg,age related macular degeneration or diabetic retinopathy).

13. The method of any one of aspects 1 to 12 for reducing or reducingthe risk of VEGF-A mediated endothelial cell maintenance orproliferation in an angiogenic disease or condition in said human.

In an example, the angiogenic disease or condition is an angiogenicdisease or condition recited above, eg, an angiogenic ocular condition.

14. The method of any one of aspects 1 to 12 for regressingneovascularisation in a VEGF-A mediated disease or condition in saidhuman.

15. The method of any one of aspects 1 to 12 for treating or reducingthe risk of neovascularisation in a human, wherein the human has VEGF-Aligand-refractory neovascularisation.

For example, the human is partially or completely resistant to treatmentwith an anti-VEGF-A ligand, eg, aflibercept, sunitinib, bevacizumab orranizumab.

16. The method of any one of aspects 1 to 15, comprising antagonisingangiopoietin-2 (Ang2) in said human.

The angiopoietins are ligands for the endothelial cell receptor Tie2 andare essential for vascular development and angiogenesis. Unlike otherfamily members, angiopoietin-2 (Ang2) is strongly up-regulated byendothelial cells at sites of angiogenesis and vascular remodelling,including tumours. Enhanced anti-tumour effects have been observed inpreclinical models with combined blockade of both VEGF and Ang2.

In an example, the method comprises administering nesvacumab (RegeneronPharmaceuticals, Inc) to the human.

17. The method of aspect 16, wherein the method comprises administeringan anti-Ang2 ligand (eg, nesvacumab) to the human simultaneously orsequentially with the anti-VEGF-A ligand.

In an example, the anti-Ang2 ligand comprises or consists of ananti-Ang2 antibody or fragment, an anti-Ang2 trap, an anti-Ang2 aptameror an anti-Ang2 NCE (so-called New Chemical Entity in the art).

18. The method of aspect 16, wherein an anti-Ang2 receptor (eg,anti-human Tie2) ligand is administered to the human simultaneously orsequentially with the anti-VEGF-A ligand.

19. The method of any one of aspects 1 to 18, wherein the human hasreceived a human Ang2 or Ang2 receptor (eg, Tie2) antagonist prior toadministering said anti-VEGF-A ligand.

20. An anti-TOI (eg, VEGF-A) ligand (eg, an antibody, antibody fragmentor TOI trap) for use in a method of any one of aspects 1 to 19.

21. The ligand of aspect 20, wherein the ligand is a human anti-VEGF-Aantibody, antibody fragment or VEGF-A trap (eg, aflibercept).

22. The ligand of aspect 20 or 21, wherein said ligand is forintravenous or subcutaneous administration and/or is comprised in aninjectable preparation.

General Optional Features Applicable to all Examples, Embodiments,Concepts & Aspects

There is optionally provided the method or ligand wherein the anti-TOI(eg, VEGF-A) ligand (eg, an antibody, antibody fragment or TOI trap)comprises a human gamma-1 heavy chain constant region that comprises anAsp corresponding to position 204 of SEQ ID NO: 42 or a Leucorresponding to position 206 of SEQ ID NO: 42 and wherein said humancomprises (i) an IGHG1*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-1heavy chain constant regions comprising an Asp corresponding to position204 of SEQ ID NO: 42 or a Leu corresponding to position 206 of SEQ IDNO: 42.

For example, the ligand is a VEGF-A trap comprising one or more humanVEGF-A receptor domain sequences fused to a human gamma-1 heavy chainconstant region, eg, a constant region as defined in the immediatelypreceding paragraph. In an example, such a trap comprises first andsecond (eg, comprises only two) VEGF-A receptor domain sequences, eg,first and second human Flt1 domain sequences; or first and second humanKDR domain sequences; or a Flt domain sequence and a KDR domainsequence. In an example, the trap comprises a human Flt1 Ig-like C2-type2 domain sequence and a human KDR Ig-like C2-type 3 domain sequence (eg,in this order in the N- to C-terminal direction).

In one embodiment, the ligand of the invention is a VEGF-A trapcomprising or of SEQ ID NO: 127, eg, comprising or consisting of a dimerof SEQ ID NO: 127.

In an example, the condition is an ophthalmic angiogenic disorder.

In an example, the condition is selected from the group consisting ofAMD, age-related macular degeneration; BRVO, branch retinal veinocclusion; CNV, choroidal neovascularization; mCNV, choroidalneovascularization caused by pathologic myopia; CRVO, central retinalvein occlusion; DME, diabetic macular edema; glaucoma; Macular edema;PCV, polypoidal choroidal vasculopathy; RAP, retinal angiomatousproliferation; retinal neovascularisation; ROP, retinopathy ofprematurity; and RVO, retinal vein occlusion.

In an example, the condition is exudative AMD.

In an example, the method is for the treatment of Adult-OnsetVitelliform Detachments Associated With Pattern Dystrophy.

In an example, the method is for the treatment of Pattern Dystrophy.

In an example, the method is for the treatment of Sub-Retinal Fibrosisin Neovascular AMD, eg, by administering Fovista® (an anti-PDGF BB) plusthe anti-VEGF ligand (eg, aflibercept, becavizumab or ranibizumab).

In an example, the human is aged >50 years, eg, the human is more than55, 60, 65 or 70 years of age.

In an example, the condition is an ocular condition and the anti-VEGF-Aligand is administered in combination with photodynamic therapy (PDT),eg, for treating or preventing PCV.

In an example, the condition is an ocular condition and the anti-VEGF-Aligand is administered in combination with laser treatment and/or IVTAtreatment, eg, for treating or preventing DME.

In an example, the condition is an ocular condition and the anti-VEGF-Aligand is administered in combination with laser photocoagulation and/orintravitreal injections of a glucocorticoid.

In an example, the condition is an ocular condition and the anti-VEGF-Aligand is administered in combination with PDT and triamcinoloneacetonide. Optionally, the ligand is administered intravitreally.

In an example the human is suffering from hypertension, hyperlipidemia,diabetes mellitus and/or arteriosclerotic vascular disorder. Optionally,the condition is RVO and further optionally the human is greater than 60years' of age.

In an example, when RVO is mentioned herein, the RVO is ischemic(non-perfusion) or non-ischemic (perfusion) RVO.

In an example, when ROP is mentioned herein, the type-1 ROP.

In an example, the condition is ROP and the anti-VEGF-A ligand isadministered in combination with laser treatment.

In an embodiment, the human has a Body Mass Index (BMI) >30 and/or thehuman is a cigarette smoker. These are risk factors, eg, wherein thedisease or condition is an ocular disease or condition.

Optionally there is less than 3 or 2 or 2 weeks between ocular diseaseor condition symptom onset and initiation of treatment with the ligandaccording to the invention.

In an example, the AMD is neovascular (nv) AMD, “wet” AMD or atrophic or“dry” AMD.

In an example, the ocular condition or disease (eg, AMD) is stage IVdisease according to the Age-Related Eye Disease Study classification(see, eg, Augood C A et al, “Prevalence of agerelated maculopathy inolder Europeans: the European Eye Study (EUREYE)”, Arch Ophthalmol.2006; 124:529e35) when the ligand is administered to the human.

In an embodiment, wherein the disease or condition is an ocular diseaseor condition (eg, AMD, PCV, DR or CNV), the ligand is administered tothe human by intraocular injection, eg, intravitreal injection.

Persistent angiogenesis may cause or exacerbate certain diseases such aspsoriasis, rheumatoid arthritis, hemangiomas, angiofibromas, diabeticretinopathy and neovascular glaucoma. An inhibitor of VEGF activitywould be useful as a treatment for such diseases and other VEGF-inducedpathological angiogenesis and vascular permeability conditions, such astumor vascularization. Thus, in an embodiment the present invention inExample 5 provides a method (or ligand for use in the method) fortreating or reducing the risk of a condition associated withangiogenesis, wherein the condition is psoriasis, rheumatoid arthritis,hemangiomas, angiofibromas, diabetic retinopathy or neovascularglaucoma. In an embodiment the present invention in Example 5 provides amethod (or ligand for use in the method) for treating or reducing therisk of tumor vascularization.

By way of example, but not limitation, the method of the invention maybe useful in treating a clinical conditions that are characterized byvascular permeability, edema or inflammation such as brain edemaassociated with injury, stroke or tumor; edema associated withinflammatory disorders such as psoriasis or arthritis, includingrheumatoid arthritis; asthma; generalized edema associated with burns;ascites and pleural effusion associated with tumors, inflammation ortrauma; chronic airway inflammation; capillary leak syndrome; sepsis;kidney disease associated with increased leakage of protein; and eyedisorders such as age related macular degeneration and diabeticretinopathy. Thus, in an embodiment the present invention in Example 5provides a method (or ligand for use in the method) for treating orreducing the risk of any one of these conditions.

In an example, the method of the present invention comprisessequentially administering multiple doses of a VEGF antagonist to apatient. The methods of the present invention include the administrationof multiple doses of a VEGF antagonist to a patient at a frequency ofonce every 8 or more weeks.

Various administration routes are contemplated for use in the methods ofthe present invention, including, e.g., topical administration orintraocular administration (e.g., intravitreal administration). Theligand (or pharmaceutical formulation comprising the ligand) may beadministered to the patient by any known delivery system and/oradministration method. In certain embodiments, the ligand isadministered to the patient by ocular, intraocular, intravitreal orsubconjunctival injection. In other embodiments, the ligand can beadministered to the patient by topical administration, e.g., via eyedrops or other liquid, gel, ointment or fluid which contains the ligandand can be applied directly to the eye. Other possible routes ofadministration include, e.g., intradermal, intramuscular,intraperitoneal, intravenous, subcutaneous, intranasal, epidural, andoral.

The amount of anti-VEGF ligand administered to the patient in each doseis, in most cases, a therapeutically effective amount. As used herein,the phrase “therapeutically effective amount” means a dose of ligandthat results in a detectable improvement in one or more symptoms orindicia of an angiogenic eye disorder, or a dose of ligand thatinhibits, prevents, lessens, or delays the progression of an angiogeniceye disorder. In the case of an anti-VEGF antibody or a VEGFreceptor-based chimeric molecule (eg, VEGF trap, eg, aflibercept) suchas VEGFR1R2-FcΔC1(a), a therapeutically effective amount can be fromabout 0.05 mg to about 5 mg, e.g., about 0.05 mg, about 0.1 mg, about0.15 mg, about 0.2 mg, about 0.25 mg, about 0.3 mg, about 0.35 mg, about0.4 mg, about 0.45 mg, about 0.5 mg, about 0.55 mg, about 0.6 mg, about0.65 mg, about 0.7 mg, about 0.75 mg, about 0.8 mg, about 0.85 mg, about0.9 mg, about 1.0 mg, about 1.05 mg, about 1.1 mg, about 1.15 mg, about1.2 mg, about 1.25 mg, about 1.3 mg, about 1.35 mg, about 1.4 mg, about1.45 mg, about 1.5 mg, about 1.55 mg, about 1.6 mg, about 1.65 mg, about1.7 mg, about 1.75 mg, about 1.8 mg, about 1.85 mg, about 1.9 mg, about2.0 mg, about 2.05 mg, about 2.1 mg, about 2.15 mg, about 2.2 mg, about2.25 mg, about 2.3 mg, about 2.35 mg, about 2.4 mg, about 2.45 mg, about2.5 mg, about 2.55 mg, about 2.6 mg, about 2.65 mg, about 2.7 mg, about2.75 mg, about 2.8 mg, about 2.85 mg, about 2.9 mg, about 3.0 mg, about3.5 mg, about 4.0 mg, about 4.5 mg, or about 5.0 mg of the antibody orreceptor-based chimeric molecule.

Dosing Regimens

Specific, non-limiting examples of dosing regimens within the scope ofthe present invention are as follows for an anti-TOI ligand (eg,anti-VEGF-A antibody or trap, eg, aflibercept):

-   -   a. ligand 2 mg (0.05 mL) administered by intravitreal injection        once every 4 weeks (monthly).    -   b. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 8 weeks, followed by 2 mg (0.05        mL) via intravitreal injection once every 8 weeks.    -   c. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 8 weeks, followed by 2 mg (0.05        mL) via intravitreal injection on a less frequent basis based on        visual and/or anatomical outcomes (as assessed by a physician or        other qualified medical professional).    -   d. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 8 weeks, followed by 2 mg (0.05        mL) via intravitreal injection administered pro re nata (PRN)        based on visual and/or anatomical outcomes (as assessed by a        physician or other qualified medical professional).    -   e. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 12 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection once every 8 weeks.    -   f. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 12 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection on a less frequent basis        based on visual and/or anatomical outcomes (as assessed by a        physician or other qualified medical professional).    -   g. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 12 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection administered pro re nata        (PRN) based on visual and/or anatomical outcomes (as assessed by        a physician or other qualified medical professional).    -   h. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 16 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection once every 8 weeks.    -   i. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 16 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection on a less frequent basis        based on visual and/or anatomical outcomes (as assessed by a        physician or other qualified medical professional).    -   j. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 16 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection administered pro re nata        (PRN) based on visual and/or anatomical outcomes (as assessed by        a physician or other qualified medical professional).    -   k. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 20 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection once every 8 weeks.    -   l. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 20 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection on a less frequent basis        based on visual and/or anatomical outcomes (as assessed by a        physician or other qualified medical professional).    -   m. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 20 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection administered pro re nata        (PRN) based on visual and/or anatomical outcomes (as assessed by        a physician or other qualified medical professional).    -   n. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 24 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection once every 8 weeks.    -   o. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 24 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection on a less frequent basis        based on visual and/or anatomical outcomes (as assessed by a        physician or other qualified medical professional).    -   p. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 24 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection administered pro re nata        (PRN) based on visual and/or anatomical outcomes (as assessed by        a physician or other qualified medical professional).    -   q. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 28 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection once every 8 weeks.    -   r. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 28 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection on a less frequent basis        based on visual and/or anatomical outcomes (as assessed by a        physician or other qualified medical professional).    -   s. ligand 2 mg (0.5 mL) administered by intravitreal injection        once every 4 weeks for the first 28 weeks, followed by 2 mg        (0.05 mL) via intravitreal injection administered pro re nata        (PRN) based on visual and/or anatomical outcomes (as assessed by        a physician or other qualified medical professional).    -   t. ligand 2 mg (0.05 mL) administered by intravitreal injection        as a single initial dose, followed by additional doses        administered pro re nata (PRN) based on visual and/or anatomical        outcomes (as assessed by a physician or other qualified medical        professional).

Variations on the above-described dosing regimens would be appreciatedby persons of ordinary skill in the art and are also within the scope ofthe present invention. For example, the amount of ligand and/or volumeof formulation administered to a patient may be varied based on patientcharacteristics, severity of disease, and other diagnostic assessmentsby a physician or other qualified medical professional.

When the method or ligand is for treating or reducing the risk of anocular condition or disease, the method in an example improves the BestCorrect Visual Acuity in the human.

Best Corrected Visual Acuity:

Visual function of the eye can be assessed using the ETDRS protocol (TheEarly Treatment Diabetic Retinopathy Study Group) at 4 meters. VisualAcuity examiners are typically certified to ensure consistentmeasurement of BCVA.

The method in an example method prevents vision loss of greater than orequal to 15 letters on the ETDRS chart, compared to baseline, at 52weeks. Additionally or alternatively the method provides one or more ofthe following: (a) change from baseline to Week 52 in letter score onthe ETDRS chart; (b) gain from baseline to Week 52 of 15 letters or moreon the ETDRS chart; (c) change from baseline to Week 52 in total NEIVFQ-25 score; and (d) change from baseline to Week 52 in CNV area (eg,where the condition is CNV).

In one embodiment, the ligand is an VEGF antagonist that comprises oneor more VEGF receptor-based chimeric molecule(s), (also referred toherein as a “VEGF-Trap” or “VEGFT”). An exemplary VEGF antagonist thatcan be used in the context of the present invention is a multimericVEGF-binding protein comprising two or more VEGF receptor-based chimericmolecules referred to herein as “VEGFR1R2-FcΔC1(a)” or “aflibercept.”

Various ligand or antibody administration routes are contemplated foruse in the methods of the present invention, including, e.g., topicaladministration or intraocular administration (e.g., intravitrealadministration).

The methods of the invention optionally comprise sequentiallyadministering to a patient multiple doses of a ligand, eg, VEGFantagonist. As used herein, “sequentially administering” means that eachdose of ligand is administered to the patient at a different point intime, e.g., on different days separated by a predetermined interval(e.g., hours, days, weeks or months). The present invention includesmethods which comprise sequentially administering to the patient asingle initial dose of a ligand, followed by one or more secondary dosesof the ligand, followed by one or more tertiary doses of the ligand.

The terms “initial dose,” “secondary doses,” and “tertiary doses,” referto the temporal sequence of administration of the ligand. Thus, the“initial dose” is the dose which is administered at the beginning of thetreatment regimen (also referred to as the “baseline dose”); the“secondary doses” are the doses which are administered after the initialdose; and the “tertiary doses” are the doses which are administeredafter the secondary doses. The initial, secondary, and tertiary dosesmay all contain the same amount of ligand, but will generally differfrom one another in terms of frequency of administration. In certainembodiments, however, the amount of ligand contained in the initial,secondary and/or tertiary doses will vary from one another (e.g.,adjusted up or down as appropriate) during the course of treatment.

Example 6 PD-L1 & PD-1

Application of PD-L1 Variation in the Present Invention

Human PD-L1 is also known as CD274, B7-H, B7H1, B7-H1, B7 homolog 1,MGC142294, MGC142296, PDCD1L1, PDCD1LG1, PDCD1 ligand 1, PDL1,Programmed cell death 1 ligand 1 and Programmed death ligand 1; and hasUniprot number Q9NZQ7 and NCBI gene ID number 29126. PD-L1 is a 290amino acid type I transmembrane protein encoded by the CD274 gene onhuman chromosome 9. PD-L1 expression is implicated in evasion of immuneresponses involved in chronic infection, e.g., by viruses (including,for example, HIV, HBV, HCV and HTLV, among others), by bacteria(including, for example, Helicobacter pylori, among others) and byparasites (including, for example, Schistosoma mansoni). CD274/PD-L1expression is also implicated in suppression of anti-tumour immuneactivity. Tumours express antigens that can be recognized by host Tcells, but immunologic clearance of tumours is rare. Part of thisfailure is due to immune suppression by the tumour microenvironment.PD-L1 expression on many tumours is a component of this suppressivemilieu and may act in concert with other immunosuppressive signals.PD-L1 expression has been shown in situ on a wide variety of solidtumours including breast, lung, colon, ovarian, melanoma, bladder,liver, salivary, stomach, gliomas, thyroid, thymic epithelial, head, andneck (Brown J A et al., 2003. J. Immunol. 170:1257-66; Dong H et al.2002. Nat. Med. 8:793-800; Hamanishi J, et al. 2007. Proc. Natl. Acad.Sci. USA 104:3360-65; Strome S E et al. 2003. Cancer Res. 63:6501-5;Inman B A et al. 2007. Cancer 109:1499-505; Konishi J et. al.. 2004.Clin. Cancer Res. 10:5094-100; Nakanishi J et. al.. 2007. CancerImmunol. Immunother. 56:1173-82; Nomi T et al. 2007. Clin. Cancer Res.13:2151-57; Thompson R H et al. 2004. Proc. Natl. Acad. Sci. USA101:17174-79; Wu C, Zhu Y, Jiang J, Zhao J, Zhang X G, Xu N. 2006. ActaHistochem. 108:19-24). In addition, PD-1 expression is upregulated ontumour infiltrating lymphocytes, and this may also contribute to tumourimmunosuppression (Blank C et al. 2003. J. Immunol. 171:4574-81). Inovarian cancer, PD-L1 expression is inversely correlated withintraepithelial, but not stromal, infiltrating CD8 T cells, suggestingthat PD-L1 inhibits the intratumor migration of CD8 T cells (Hamanishi Jet. al.. 2007. Proc. Natl. Acad. Sci. USA 104:3360-65). Translation ofPD-L1 mRNA is enhanced by loss of PTEN and the ensuing activation ofAkt, a common event in tumourigenesis (Parsa A T et al. 2007. Nat. Med.13:84-88). Most importantly, studies relating PD-L1 expression ontumours to disease outcome show that PD-L1 expression stronglycorrelates with unfavorable prognosis in kidney, ovarian, bladder,breast, gastric, and pancreatic cancer (Hamanishi J et al. 2007. Proc.Natl. Acad. Sci. USA 104:3360-65; Inman B A et al. 2007. Cancer109:1499-505; Konishi J et. al.. 2004. Clin. Cancer Res. 10:5094-100;Nakanishi J et. al.. 2007. Cancer Immunol. Immunother. 56:1173-82; NomiT et al. 2007. Clin. Cancer Res. 13:2151-57; Thompson R H et al. 2004.Proc. Natl. Acad. Sci. USA 101:17174-79; Wu C, Zhu Y, Jiang J, Zhao J,Zhang X G, Xu N. 2006. Acta Histochem. 108:19-24). In addition, thesestudies suggest that higher levels of PD-L1 expression on tumours mayfacilitate advancement of tumour stage and invasion into deeper tissuestructures.

The PD-1 pathway can also play a role in hematologic malignancies. PD-L1is expressed on multiple myeloma cells but not on normal plasma cells(Liu J et al. 2007. Blood 110:296-304). PD-L1 is expressed on someprimary T cell lymphomas, particularly anaplastic large cell T lymphomas(Brown J A et al., 2003. J. Immunol 170:1257-66). PD-1 is highlyexpressed on the T cells of angioimmunoblastic lymphomas, and PD-L1 isexpressed on the associated follicular dendritic cell network (Dorfman DM et al. 2006. Am. J. Surg. Pathol. 30:802-10). In nodularlymphocyte-predominant Hodgkin lymphoma, the T cells associated withlymphocytic and/or histiocytic (L&H) cells express PD-1. Microarrayanalysis using a readout of genes induced by PD-1 ligation suggests thattumour-associated T cells are responding to PD-1 signals in situ inHodgkin lymphoma (Chemnitz J M et al. 2007. Blood 110:3226-33). PD-1 andPD-L1 are expressed on CD4 T cells in HTLV-1-mediated adult T cellleukemia and lymphoma (Shimauchi T et al. 2007. Int. J. Cancer 121:2585-90). These tumour cells are hyporesponsive to TCR signals.

Studies in animal models demonstrate that PD-L1 on tumours inhibits Tcell activation and lysis of tumour cells and in some cases leads toincreased tumour-specific T cell death (Dong H et al. 2002. Nat. Med.8:793-800; Hirano F et al. 2005. Cancer Res. 65:1089-96).Tumour-associated APCs can also utilize the PD-1:PD-L pathway to controlantitumor T cell responses. PD-L1 expression on a population oftumour-associated myeloid DCs is upregulated by tumour environmentalfactors (Curiel T J et al. 2003. Nat. Med. 9:562-67). Plasmacytoiddendritic cells (DCs) in the tumour-draining lymph node of B 16 melanomaexpress IDO, which strongly activates the suppressive activity ofregulatory T cells. The suppressive activity of IDO-treated regulatory Tcells required cell contact with IDO-expressing DCs (Sharma M D et al.2007. J. Clin. Invest. 117:2570-82).

U.S. Pat. No. 8,507,663 discusses the specific inhibition of theexpression of the CD274/PD-L1 gene. Reference is also made toWO2011066389, WO2010036959, WO 2010077634, WO 03099196, WO 2013181634,WO2007005874, US20090317368 and U.S. Pat. No. 7,635,757.

The inventor carried out natural human variation in PD-L1 and identifiedthe following variations of interest for application to the presentinvention.

TABLE 21 Human PD-L1 Variation CHROMOSOMAL LOCATION AMINO AMINO (FORWARDNUCLEOTIDE ACID ACID CUMULATIVE SNP/VARIANT STRAND) CHANGE¹ CHANGE²POSITION³ FREQUENCY⁴ rs150439231 9:5448539 rs138261640 9:5448573rs142983488 9:5448634 rs76741468 9:5448641 rs822336 9:5448690rs183400620 9:5448763 rs187252832 9:5448815 rs146143976 9:5448859rs139023765 9:5448896 rs73641615 9:5448956 rs17718883 9:5462876 P/R 146rs139709512 9:5456126 A/P 5 rs140045210 9:5462881 T/S 148 rs1419786429:5466785 V/E 269 rs146495642 9:5462929 G > A E/K 164 rs3708002609:5457087 G > A V/I 21 rs143235887 9:5457091 C > T T/M 22 rs3736925529:5457117 G > C E/Q 31 rs140304675 9:5457127 G > C S/T 34 rs125513339:5457171 G > C D/H 49 rs376993991 9:5457282 C > T R/W 86 rs3679217139:5462893 G > A E/K 152 rs41280721 9:5462997 A > C R/S 186 rs617528609:5465514 A > T H/L 233 rs148141792 9:5465595 G > A R/H 260 rs3693508139:5467858 C > T T/M 290 rs10481593 9:5458095 rs2282055 9:5455732rs2297135 9:5470108 rs2297136 9:5467955 rs2297137 9:5465732 rs37803959:5464552 rs7023227 9:5456550 8923 A > C rs1411262 9:5459419 C > T 6777C > G rs4143815 9:5468257 395 G > C rs34028061 9:5454629-5454630 AT > —deletion 0.476 rs7041009 9:5463243 G > A 0.459 rs1481709259:5454642-5454643 TG > — deletion 0.600 rs1411262 9:5459419 C/T 0.395rs10114060 9:5461729 G/A 0.382 rs1536926 9:5463988 G/T 0.360 rs70420849:5458035 G/T 0.352 ^(1, 2, 3, 4)According to Ensembl, dbSNP; withreference to transcript ENST00000381577 (the sequence of this transcriptbeing incorporated herein in its entirety).

The table is to read as follows: For example, the following forrs12551333 means Asp49His, ie, a histidine at position 49 encoded by SNPrs12551333

D/H 49

REFERENCES

-   1. Asia Pac J Clin Oncol. 2014 June; 10(2):e1-6. doi:    10.1111/ajco.12037. Epub 2012 Nov. 21; “Association between single    nucleotide polymorphism of PD-L1 gene and non-small cell lung cancer    susceptibility in a Chinese population”; Chen Y et al.

The authors published the following:—

Aim:

To evaluate the correlation between a polymorphism of PD-L1 gene and thesusceptibility of non-small cell lung cancer (NSCLC) in a Chinesepopulation.

Methods:

A total of 293 Chinese patients with NSCLC and 293 age and sex matchedcontrols of the same ethnic origin were enrolled in this study. A/Cpolymorphism at position 8923 in intron 4 of PD-L1 gene was typed usingthe polymerase chain reaction-restriction fragment length polymorphismmethod (PCR-RFLP). The interactions between A/C genotype, allelefrequency and NSCLC susceptibility were analyzed.

Results:

The A/C genotype frequencies were significantly different between NSCLCpatients and controls. The AC and CC frequencies were higher in NSCLCpatients than in controls (16.4 vs 8.9%, 1.0 vs 0.3%, respectively). TheC-allele frequency was higher in NSCLC patients than in controls (9.2 vs4.8%). Significant differences in the A and C allele frequencies werenoted between the two groups (χ(2)=8.864, P=0.003). More risk of NSCLCwas found in individuals carrying the C allele than in those carryingthe A allele (OR=2.203; 95% CI 1.262-3.242). In both light smokers (≦20pack-years) and heavy smokers (>20 pack-years), individuals carrying theC-allele had more risk of NSCLC than those carrying the A-allele (lightsmokers OR=1.847, 95% CI 1.001-3.409; heavy smokers OR=3.252, 95% CI1.196-8.845, respectively).

Conclusion:

An A/C polymorphism at position 8923 in the PD-L1 gene is associatedwith NSCLC susceptibility. The PD-L1 polymorphism plays a role in NSCLC,especially in patients with the C-allele.

-   2. Eur J Endocrinol. 2008 June; 158(6):817-22. doi:    10.1530/EJE-07-0649. Epub 2008 Mar. 5. “Association of an A/C single    nucleotide polymorphism in programmed cell death-ligand 1 gene with    Graves' disease in Japanese patients”; Hayashi M et al.

The authors published the following:—

Objective:

Programmed cell death-1 (PD-1) and its ligands (PD-L1 and PD-L2) inhibitT-cell proliferation and activation. This inhibition down-regulates theimmune responses. The association of a PD-L1 polymorphism with Graves'disease (GD) was studied.

Design:

The association of an A/C polymorphism at position 8923 in PD-L1 intron4 with GD was studied.

Patients:

The study included 327 GD patients and 192 controls, of which 252 GDpatients were followed over 5-10 years.

Measurements:

PD-L1 intron 4 position 8923 A/C polymorphism was typed using thePCR-restriction fragment length polymorphism method.

Results:

The A/C genotype frequencies were significantly different between GDpatients and controls. The A/C and C/C frequencies were higher in GDpatients than in controls. The A/A frequencies were lower in GD patientsthan in controls. C-allele frequency was higher in GD patients than incontrols. A total of 252 GD patients were followed over 5-10 years; 200had discontinued antithyroid drugs (ATD) while 52 continued to take ATD.Of these 200, 176 continued to be in remission and 24 had relapsed intohyperthyroidism. Significant differences in the duration of positiveTBII, positive thyroid-stimulating antibodies, and ATD treatment werenoted between the patients in remission and those that had relapsed.Significant differences in the A- and C-allele frequencies were notedbetween the two. The C-allele frequency was higher in GD patients whodid not achieve remission than in those who achieved remission.

Conclusion:

An A/C polymorphism at position 8923 in PD-L1 is associated with GD. ThePD-L1 polymorphism plays a role in GD development. GD patients with theC allele at position 8923 in PD-L1 gene had difficulty in achievingremission.

-   3. Rheumatology (Oxford). 2011 October; 50(10):1809-13. doi:    10.1093/rheumatology/ker211. Epub 2011 Jul. 26; “Effects of genetic    polymorphisms of programmed cell death 1 and its ligands on the    development of ankylosing spondylitis”; Huang C et al.

Human subjects with the PD-1 GG genotype had significantly greater riskfor ankylosing spondylitis (AS) than those with the AA genotype.Subjects with the PD-L2 CT genotype had lower risk for AS than thosewith the CC genotype. The combined genotypes of PD-1 G-536A, PD-L1A8923C and PD-L2 C47103T also appear to be associated with ASdevelopment.

Conclusions.

The results suggest that PD-1 G-536A, PD-L1 A8923C and PD-L2 C47103Tpolymorphisms are associated with the presence of AS.

-   4. J Clin Endocrinol Metab. 2009 December; 94(12):5139-45. doi:    10.1210/jc.2009-1404. Epub 2009 Oct. 22; “Programmed death ligand 1    (PD-L1) gene variants contribute to autoimmune Addison's disease and    Graves' disease susceptibility”; Mitchell A L et al.

The authors published the following:—

Context:

Despite much investigation, a substantial amount of the geneticsusceptibility to autoimmune diseases remains unaccounted for. Recently,a single-nucleotide polymorphism (SNP) in the programmed death ligand 1(PD-L1) gene has been associated with Graves' disease (GD) in a Japanesepatient cohort. Our aim was to determine whether variants in PD-L1 arealso associated with autoimmune Addison's disease (AAD) and to replicatethe previous association in patients with GD from the United Kingdom.

Design and Patients:

We analyzed eight SNPs within PD-L1 in a United Kingdom cohort of 315AAD subjects and 316 healthy controls. We then replicated our experimentin a cohort of 342 Norwegian AAD cases and 379 controls and in 496United Kingdom GD subjects.

Results:

Three of the eight SNPs studied, part of a haplotype block in the PD-L1gene, showed modest association with both AAD and GD in the UnitedKingdom cohort, with maximum evidence at the marker RS1411262 [UnitedKingdom AAD odds ratio 1.33 (5-95% confidence interval 1.02-1.73),P(genotype)=0.028; GD odds ratio 1.36 (5-95% confidence interval1.07-1.72), P(genotype)=0.033]. Association with genotypes at the samethree markers was confirmed in the Norwegian AAD cohort[P(genotype)=0.011-0.020]. A recessive effect at the most associatedalleles was observed in both the AAD and GD cohorts.

Conclusions:

We confirm the role of PD-L1 variants in GD susceptibility and extendthese findings to demonstrate association in two Northern Europeanpatient cohorts with AAD. PD-L1 joins the growing number of knownsusceptibility loci exerting modest effects in these autoimmunedisorders.

-   5. J Clin Immunol. 2007 November; 27(6):563-7. Epub 2007 Jun. 28;    “Polymorphisms of genes for programmed cell death 1 ligands in    patients with rheumatoid arthritis”; Wang S C et al.

The authors published the following:—

To investigate the role of ligands for programmed cell death 1 (PD-L) inthe pathogenesis of rheumatoid arthritis (RA), 129 patients with RA and125 unrelated healthy controls were enrolled in this study. The PD-L1and PD-L2 polymorphisms were determined by the method of polymerasechain reaction (PCR)/direct sequencing or PCR/reaction fragment lengthpolymorphisms. The genotype distributions of PD-L1 6777 C/G were notsignificantly different between the patients with RA and healthycontrols. There was also no significant difference in the allelefrequencies of PD-L1 6777 C/G polymorphisms between the patients with RAand controls. Similar findings could also be found in the phenotypes andalleles frequencies of PD-L2 47103 C/T and 47139 T/C polymorphismsbetween the patients with RA and controls. The patients with PD-L1 6777G had higher prevalence of rheumatoid nodule in comparison with thosewithout PD-L1 6777 G (p=0.005, OR=4.0, 95% CI=1.5-10.9). In contrast,the PD-L2 47103 C/T and 47139 T/C polymorphisms were not related to theoccurrence of rheumatoid nodule. This study demonstrated that the PD-L1and PD-L2 polymorphisms were not associated with susceptibility to RA inTaiwan. PD-L1 6777 G was associated with the prevalence of rheumatoidnodule.

-   6. Hum Genet. 2013 June; 132(6):641-8. doi:    10.1007/s00439-013-1275-6. Epub 2013 Feb. 21; “A miR-570 binding    site polymorphism in the B7-H1 gene is associated with the risk of    gastric adenocarcinoma”; Wang W et al.

Since the over-expression of B7-H1 protein has been reported to beclosely related to disease progression of gastric cancer, the authorsinvestigated the possible role of miRSNPs at the 3′-untranslated region(3′-UTR) of B7-H1 in the risk of developing gastric cancer. In thisassociation study on 205 gastric adenocarcinoma patients and 393non-cancer controls, they found that the genotype distribution of acommon C>G polymorphism (rs4143815) was significantly different betweenthe cases and controls (P=1.32×10(−8)). Compared with CC homozygotes, GGhomozygotes and G allele carriers showed 3.73-fold (P=2.98×10(−8)) and1.85-fold (P=0.002) increased risk of gastric adenocarcinoma,respectively. Stratified analyses indicated that variant genotypes had astrong association with the clinic-pathological features of gastriccancer including differentiation grade, depth of tumor infiltration, andtumor node metastasis (TNM) stage (P<0.001). Luciferase reporter assayindicated that this SNP might be responsible for aberrant B7-H1 proteinexpression in gastric cancer by disrupting the interaction betweenmiR-570 and B7-H1 mRNA. These results are consistent with our hypothesisand indicate that genetic polymorphisms influencing B7-H1 expressionmodify cancer susceptibility.

-   7. Clinical cancer research: an official journal of the American    Association for Cancer Research/15(3):971-9; Pub Date: Feb. 1, 2009;    “Overexpression of PD-L1 significantly associates with tumor    aggressiveness and postoperative recurrence in human hepatocellular    carcinoma”; Qiang G et al.

The authors published the following:—

PURPOSE

The aberrant expression of programmed cell death 1 ligands 1 and 2(PD-Ls) on tumor cells dampens antitumor immunity, resulting in tumorimmune evasion. In this study, we investigated the expression of PD-Lsin human hepatocellular carcinoma (HCC) to define their prognosticsignificance after curative surgery.

EXPERIMENTAL DESIGN

Immunohistochemistry was used to investigate PD-Ls expression as well asgranzyme B+cytotoxic and FoxP3+ regulatory T cell infiltration on tissuemicroarrays containing 240 randomly selected HCC patients who underwentsurgery. The results were further verified in an independent cohort of125 HCC patients. PD-Ls expression on HCC cell lines was detected byWestern blot assay.

RESULTS

Patients with higher expression of PD-L1 had a significantly poorerprognosis than patients with lower expression. Although patients withhigher expression of PD-L2 also had a poorer survival, the difference inrecurrence was not statistically significant. Multivariate analysisidentified tumor expression of PD-L1 as an independent predictor forpostoperative recurrence. No correlation was found between PD-Lsexpression and granzyme B+ lymphocyte infiltration, whereas asignificant positive correlation was detected between PD-Ls expressionand FoxP3+ lymphocyte infiltration. In addition, tumor-infiltratingcytotoxic and regulatory T cells were also independent prognosticatorsfor both survival and recurrence. The prognostic value of PD-L1expression was validated in the independent data set.

CONCLUSION

Our data suggest for the first time that PD-L1 status may be a newpredictor of recurrence for HCC patients and provide the rationale fordeveloping a novel therapy of targeting the PD-L1/PD-1 pathway againstthis fatal malignancy.

Using this analysis, the inventor has devised the following aspects ofthe invention that are useful for addressing PD-L1-mediated diseases andconditions, such as cancer, autoimmune or inflammatory diseases andconditions as more fully described below. Thus, the invention providesthe following aspects.

In an example, the invention provides a method of treating or reducingthe risk of a PD-L1-mediated disease or condition in a human in needthereof, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human PD-L1protein. The invention also provides a corresponding ligand. In anembodiment, the PD-L1 is encoded by a PD-L1 nucleotide sequencecomprising a variation set out in Table 21, eg, comprising one or moreof said SNPs (eg, RS1411262 and/or rs4143815; or 8923C and/or 395C). Ina preferred embodiment, the variation is 8923C.

The present invention provides anti-PD-L1 ligands; and PD-L1-binding ortargeting ligands as described herein. The ligands have a variety ofutilities. Some of the ligands, for instance, are useful in specificbinding assays, for genotyping or phenotyping humans, affinitypurification of PD-L1, in particular human PD-L1 or its ligands and inscreening assays to identify other antagonists of PD-L1 activity. Someof the ligands of the invention are useful for inhibiting PD-L1-mediatedactivities.

Anti-PD-L1 ligands (eg, antibodies and anti-sense RNA) have beendeveloped based on targeting and neutralising so-called “wild-type”human PD-L1, which is a commonly-occurring form. While such therapiesare useful for human patients harbouring this form of human PD-L1, theinventor considered it useful to investigate the possibility oftargeting rarer—but still naturally-occurring—forms of PD-L1 amongsthuman populations. In this way, the inventor arrived at insight into thenatural occurrences and distributions of rarer human PD-L1 forms thatcan serve as useful targets (at the protein or nucleic acid level) forhuman treatment, prophylaxis and diagnosis pertinent to diseases andconditions mediated or associated with PD-L1 activity. This particularlyprovides for tailored therapies, prophylaxis and diagnosis in humansthat are devoid of the common PD-L1 gene or protein.

The skilled person will know that SNPs or other changes that translateinto amino acid variation can cause variability in activity and/orconformation of human targets to be addressed. This has spawned greatinterest in personalized medicine where genotyping and knowledge ofprotein and nucleotide variability is used to more effectively tailormedicines and diagnosis of patients. The invention, therefore, providesfor tailored pharmaceuticals and testing that specifically addressesrarer PD-L1 polymorphic variant forms. Such forms or “alleles” (at thenucleotide level), comprise one or more changes at the nucleotide andamino acid levels from the corresponding common form nucleotide andamino acids sequences, ie, there are one or more non-synonymous (aka“missense”) changes at the nucleotide level that translate into one ormore corresponding changes in the protein target in humans.

Furthermore, the inventor surprisingly realised that the rarer naturalforms, although present in humans at much lower frequencies than thecommon form, nevertheless are represented in multiple andethnically-diverse human populations and usually with many humanexamples per represented ethnic population. Thus, the inventor realisedthat targeting such rarer forms would provide for effective treatment,prophylaxis or diagnosis across many human ethnic populations, therebyextending the utility of the present invention. In particular, humanPD-L1 variations are correlated with increased incidence or risk ofPD-L1 mediated diseases or conditions, such as cancer. The inventoranalysed such variations and devised the collections of variants inTable 21. In this respect, therefore, the invention provides variousaspects and aspects as set out below in this example.

The inventor saw that there is significant industrial and medicalapplication for the invention in terms of guiding the choice of anti-TOI(PD-L1) ligand for administration to human patients for therapy and/orprophylaxis of PD-L1-mediated or associated diseases or conditions. Inthis way, the patient receives drugs and ligands that are tailored totheir needs—as determined by the patient's genetic or phenotypic makeup.Hand-in-hand with this, the invention provides for the genotyping and/orphenotyping of patients in connection with such treatment, therebyallowing a proper match of drug to patient. This increases the chancesof medical efficacy, reduces the likelihood of inferior treatment usingdrugs or ligands that are not matched to the patient (eg, poor efficacyand/or side-effects) and avoids pharmaceutical mis-prescription andwaste.

In developing this thinking, in a non-limiting embodiment the presentinventor decided to determine a set of human PD-L1 variants on the basisof the following criteria, these being criteria that the inventorrealised would provide for useful medical drugs and diagnostics totailored need in the human population. In an embodiment the inventorselected variants having at least 3 of the 4 following criteria:—

-   -   Naturally-occurring human TOI variation having a cumulative        human allele frequency of 49 or 35% or less;    -   Naturally-occurring human TOI variation having a total human        genotype frequency of about 50% or less;    -   Naturally-occurring human TOI variation found in many different        human ethnic populations (using the standard categorisation of        the 1000 Genomes Project; see Table 2 below); and    -   Naturally-occurring human TOI variation found in many        individuals distributed across such many different ethnic        populations.

In an example, the ligand of the invention comprises an anti-human PD-L1binding site, wherein the binding site is a human or humanized bindingsite, eg, the binding site comprises or consists of a human or humanizedantibody variable domain or plurality of variable domains (eg, humanVH/VL binding site(s)). Additionally or alternatively, the ligandcomprises one or more human antibody constant regions (eg, a humanantibody CH1, CH2, CH3 (or all of these) or Fc). In an example, theligand is an antibody that comprises human or humanized variable regionsand human constant regions (eg, bearing one or more mutations to enhanceor dampen Fc function in a human patient).

In an example, the invention provides a method of targeting PD-L1 in ahuman, the method comprising administering to said human a ligand (eg,an antibody or antibody fragment) that specifically binds a human PD-L1protein that is encoded by a human PD-L1 nucleotide comprising a PD-L1variation as described herein. In an example, the human is sufferingfrom or at risk of a PD-L1-mediated disease or condition. In an example,the method treats or reduces the risk of a PD-L1-mediated disease orcondition in the human.

In an embodiment, (i) the antibody or fragment comprises a VH domainderived from the recombination of a human VH segment, a human D genesegment and a human JH segment, the human VH segment encoding theframework 1 of SEQ ID NO: 40 and wherein said human comprises a VH genesegment encoding the framework 1 of SEQ ID NO: 40, or the humanexpresses VH domains that comprise the framework 1 of SEQ ID NO: 40.

Preferably, additionally or alternatively in an embodiment theanti-PDL-1 ligand (eg, antibody or fragment) comprises a gamma-1constant region (eg, an IGHG1*01 constant region) as described herein.

Additionally or alternatively, in an embodiment, (i) the antibody orfragment comprises a human gamma-4 heavy chain constant region thatcomprises a Leu at position 189 shown in SEQ ID NO: 73 or an Arg atposition 289 shown in SEQ ID NO: 73 and wherein said human comprises anIGHG4*01 human heavy chain constant region gene segment, or the humanexpresses antibodies comprising human gamma-4 heavy chain constantregions comprising a Leu at position 189 shown in SEQ ID NO: 73 or anArg at position 289 shown in SEQ ID NO: 73.

In a specific embodiment, the anti-PD-L1 ligand, antibody or fragment ofpresent invention comprises an Fc region, wherein the Fc regioncomprises at least one non-native amino acid residue selected from thegroup consisting of 234D, 234E, 234N, 234Q, 234T, 234H, 234Y, 2341,234V, 234F, 235A, 235D, 235R, 235W, 235P, 235S, 235N, 235Q, 235T, 235H,235Y, 235I, 235V, 235F, 236E, 239D, 239E, 239N, 239Q, 239F, 239T, 239H,239Y, 240I, 240A, 240T, 240M, 241W, 241 L, 241Y, 241E, 241R. 243W, 243L243Y, 243R, 243Q, 244H, 245A, 247L, 247V, 247G, 251F, 252Y, 254T, 255L,256E, 256M, 262I, 262A, 262T, 262E, 263I, 263A, 263T, 263M, 264L, 264I,264W, 264T, 264R, 264F, 264M, 264Y, 264E, 265G, 265N, 265Q, 265Y, 265F,265V, 265I, 265L, 265H, 265T, 266I, 266A, 266T, 266M, 267Q, 267L, 268E,269H, 269Y, 269F, 269R, 270E, 280A, 284M, 292P, 292L, 296E, 296Q, 296D,296N, 296S, 296T, 296L, 296I, 296H, 269G, 297S, 297D, 297E, 298H, 298I,298T, 298F, 299I, 299L, 299A, 299S, 299V, 299H, 299F, 299E, 305I, 313F,316D, 325Q, 325L, 325I, 325D, 325E, 325A, 325T, 325V, 325H, 327G, 327W,327N, 327L, 328S, 328M, 328D, 328E, 328N, 328Q, 328F, 328I, 328V, 328T,328H, 328A, 329F, 329H, 329Q, 330K, 330G, 330T, 330C, 330L, 330Y, 330V,330I, 330F, 330R, 330H, 331G, 331A, 331L, 331M, 331F, 331W, 331K, 331Q,331E, 331S, 331V, 331I, 331C, 331Y, 331H, 331R, 331N, 331D, 331T, 332D,332S, 332W, 332F, 332E, 332N, 332Q, 332T, 332H, 332Y, 332A, 339T, 370E,370N, 378D, 392T, 396L, 416G, 419H, 421K, 440Y and 434W as numbered bythe EU index as set forth in Kabat. Optionally, the Fc region maycomprise additional and/or alternative non-native amino acid residuesknown to one skilled in the art (see, e.g., U.S. Pat. Nos. 5,624,821;6,277,375; 6,737,056; PCT Patent Publications WO 01/58957; WO 02/06919;WO 04/016750; WO 04/029207; WO 04/035752 and WO 05/040217).

The ligand, antibody or fragment according to the invention (eg, ananti-PD-L1 antibody or fragment) is for treating or preventing orreducing the risk of (or treats or prevents or reduces the risk of), forexample, any disease or condition disclosed in U.S. Pat. No. 8,507,663,WO2011066389, WO2010036959, WO 2010077634, WO 03099196, WO 2013181634,WO2007005874, US20090317368 or U.S. Pat. No. 7,635,757, the disclosureof which diseases and conditions are incorporated herein by referencefor potential inclusion in one or more aspects herein. Guidance onobtaining and testing antibodies can also be found in thesepublications. Suitable anti-PD-L1 ligands, antibodies or fragments foruse in the invention are disclosed in these publications, the disclosureof which (including sequences thereof) are incorporated herein byreference for potential inclusion in one or more aspects herein.

Further encompassed by the invention is the use of the anti-PD-L1ligand, antibody or fragment of an in the manufacture of a medicamentfor use to attenuate or inhibit a PD-L1-mediated disease or disorder ina human. PD-L1-mediated or related disorders which are treated by theligand, antibody or fragment of the invention include, for example,described below.

Thus, a ligand, antibody or fragment of the invention is useful as atherapeutic agent in the treatment of a condition involving PD-L1expression and/or activity. One embodiment, among others, is a method oftreatment comprising administering an effective amount of a ligand,antibody or fragment of the invention to a patient in need thereof,wherein functional consequences of PD-L1 activation are decreased.Another embodiment, among others, is a method of treatment comprising(i) identifying a patient demonstrating PD-L1 expression or activity,and (ii) administering an effective amount of a ligand, antibody orfragment of the invention to the patient, wherein a functionalconsequence of PD-L1 activation are attenuated. An effective amountaccording to the invention is an amount that modulates (e.g. decreases)the functional consequences of PD-L1 activation so as to modulate (e.g.decrease or lessen) the severity of at least one symptom of theparticular disease or disorder being treated, but not necessarily curethe disease or disorder. Accordingly, one embodiment of the invention isa method of treating or reducing the severity of at least one symptom ofany of the disorders referred to herein, comprising administering to apatient in need thereof an effective amount of one or more ligands,antibodies or fragments of the present invention alone or in a combinedtherapeutic regimen with another appropriate medicament known in the artor described herein such that the severity of at least one symptom ofany of the disorders is reduced. Another embodiment of the invention,among others, is a method of antagonizing at least one effect of PD-L1comprising contacting with or administering an effective amount of oneor more ligands, antibodies or fragments of the present invention suchthat said at least one effect of PD-L1 is antagonized, e.g. the abilityto promote or maintain cancer, an autoimmune condition or aninflammatory condition.

Tailoring Anti-PD-L1 Ligands

As outlined herein (for example, in the context of PCSK9 in Example 1),the invention includes the possibility to tailor treatment of humansfurther by selecting antibody-based ligands with variable domains and/orconstant domains based on gene segments found in many humans of theethnic populations where the variant TOI forms are found to meet theselection criteria of the invention. This also applies mutatis mutandiswhere the TOI is human PD-L1 as in the present example. Thus, alldisclosure herein relating to tailoring variable and/or constant domainsapply to the present example, relating to PD-L1 and is combinable foruse in one or more aspects herein.

As described in Example 1, an example is provided for ligands comprisingantibody VH domains derived from recombination of human IGHV genesegments comprising selected nucleotides at positions in the HCDR1 orFW3 where there is variability in humans (ie, where SNPs occur inhumans).

Further information is provided in Table 4, which shows variation atthese positions, as well as the variant distributions across the 1000Genomes Project database relating to many human populations.

In other embodiments, as explained more fully above, the inventionprovides for ligands which are tailored to the human recipient'sgenotype and/or phenotype based on alternative human VH gene segments,or on Vκ, Vλ or constant region gene segments (see further Table 9 forrepresentative variants).

Further examples, therefore are:—

(i) wherein the ligand comprises a VH domain derived from therecombination of a human VH segment (eg, human VH3-23*04), a human Dgene segment and a human JH segment, the human VH segment encoding theframework 1 of SEQ ID NO: 40 and wherein said human comprises a VH genesegment encoding the framework 1 of SEQ ID NO: 40, or the humanexpresses VH domains that comprise the framework 1 of SEQ ID NO: 40.(ii) wherein the ligand comprises a VH domain derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment, and wherein said human comprises a IGHV3-7*01 VHgene segment or the human expresses VH domains derived from therecombination of human VH segment IGHV3-7*01, a human D gene segment anda human JH segment.(iii) wherein the ligand comprises a Vκ domain derived from therecombination of human Vκ segment IGKV1-12*01 and a human Jκ segment,and wherein said human comprises a IGKV1-12*01 Vκ gene segment or thehuman expresses Vκ domains derived from the recombination of human Vκsegment IGKV1-12*01 and a human Jκ segment.(iv) wherein the ligand comprises a Vκ domain derived from therecombination of a human Vκ segment and a human Jκ segment, the human Vκsegment encoding (i) a CDR3 comprising a Pro at position 7 shown in SEQID NO: 36 and wherein said human comprises a Vκ gene segment encoding aCDR3 comprising a Pro at position 7 shown in SEQ ID NO: 36, or the humanexpresses Vκ domains that comprise a CDR3 comprising a Pro at position 7shown in SEQ ID NO: 36; or (ii) a FW3 comprising a Ser at position 15shown in SEQ ID NO: 38 and wherein said human comprises a Vκ genesegment encoding a FW3 comprising a Ser at position 15 shown in SEQ IDNO: 38 or the human expresses Vκ domains that comprise a FW3 comprisinga Ser at position 15 shown in SEQ ID NO: 38.(v) wherein the ligand comprises a human gamma-1 heavy chain constantregion that comprises an Asp at position 204 shown in SEQ ID NO: 4 or aLeu at position 206 shown in SEQ ID NO: 4 and wherein said humancomprises (i) an IGHG1*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-1heavy chain constant regions comprising an Asp at position 204 shown inSEQ ID NO: 4 or a Leu at position 206 shown in SEQ ID NO: 4.(vi) wherein the ligand comprises a human gamma-2 heavy chain constantregion that comprises an amino acid selected from the group consistingof a Pro at position 72 shown in SEQ ID NO: 6, an Asn at position 75shown in SEQ ID NO: 6, a Phe at position 76 shown in SEQ ID NO: 6, a Valat position 161 shown in SEQ ID NO: 6 and an Ala at position 257 shownin SEQ ID NO: 6 and wherein said human comprises (i) an IGHG2*01 humanheavy chain constant region gene segment, or the human expressesantibodies comprising human gamma-2 heavy chain constant regionscomprising said selected Pro at position 72 shown in SEQ ID NO: 6, Asnat position 75 shown in SEQ ID NO: 6, Phe at position 76 shown in SEQ IDNO: 6, Val at position 161 shown in SEQ ID NO: 6 or Ala at position 257shown in SEQ ID NO: 6. In an example, the constant region is Fcenhanced, eg, ADCC or CDC enhanced. The skilled person will knowtechniques (eg, known C region mutations) to enhance ADCC or CDC.(vii) wherein the ligand comprises a human kappa chain constant regionthat comprises a Val at position 84 shown in SEQ ID NO: 16 or a Cys atposition 87 shown in SEQ ID NO: 16 and wherein said human comprises (i)an IGKC1*01 human kappa chain constant region gene segment, or the humanexpresses antibodies comprising human kappa chain constant regionscomprising a Val corresponding to position 84 shown in SEQ ID NO: 16 ora Cys at position 87 shown in SEQ ID NO: 16.(viii) wherein the ligand comprises a human IGLC1*01 lambda chainconstant region and wherein said human comprises (i) a human IGLC1*01lambda chain constant region gene segment, or the human expressesantibodies comprising human IGLC1*01 lambda chain constant regions.(ix) wherein the ligand comprises a human gamma-4 heavy chain constantregion that comprises a Leu at position 189 shown in SEQ ID NO: 73 or anArg at position 289 shown in SEQ ID NO: 73 and wherein said humancomprises (i) an IGHG4*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-4heavy chain constant regions comprising a Leu at position 189 shown inSEQ ID NO: 73 or an Arg at position 289 shown in SEQ ID NO: 73.(x) wherein the ligand comprises a human gamma-3 heavy chain constantregion encoded by a first human IGHG3 (eg, IGHG3*01) constant regiongene segment and wherein said human comprises (i) said first constantregion gene segment (eg, an IGHG3*01), or the human expresses antibodiescomprising human gamma-3 heavy chain constant regions encoded by saidfirst human IGHG3 (eg, IGHG3*01) constant region gene segment.(xi) wherein the ligand comprises a human epsilon heavy chain constantregion encoded by a first human epsilon heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human epsilonheavy chain constant regions encoded by said first constant region genesegment.(xii) wherein the ligand comprises a human mu heavy chain constantregion encoded by a first human mu heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human muheavy chain constant regions encoded by said first constant region genesegment.(xiii) wherein the ligand comprises a human alpha heavy chain constantregion encoded by a first human alpha heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human alphaheavy chain constant regions encoded by said first constant region genesegment.(xiv) wherein the ligand comprises a human delta heavy chain constantregion encoded by a first human delta heavy chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human deltaheavy chain constant regions encoded by said first constant region genesegment.(xv) wherein the ligand comprises a human kappa light chain constantregion encoded by a first human kappa light chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human kappalight chain constant regions encoded by said first constant region genesegment.(xvi) wherein the ligand comprises a human lambda light chain constantregion encoded by a first human lambda light chain constant region genesegment and wherein said human comprises (i) said first constant regiongene segment, or the human expresses antibodies comprising human lambdalight chain constant regions encoded by said first constant region genesegment.

Generally, in an example the ligand comprises a heavy chain constantregion that is Fc enhanced, eg, ADCC or CDC enhanced. The skilled personwill know techniques (eg, known C region mutations; defucosylation toenhance ADCC) to enhance ADCC or CDC. This applies to any of Examples 1onwards herein.

Thus, it may be advantageous for PD-L1 ligands, for the ligand tocomprise a gamma-1 or gamma-2 constant region (eg, as per theembodiments (i) to (xvi) above). For example, the ligand comprises saidgamma-1 constant region, eg, an ADCC or CDC enhanced constant regionmeeting embodiment (v).

In an example, the ligand (eg, an antibody) is conjugated to a cytokineselected from the group consisting of IL-2, IL-12, IL-15 or IL-21. In anexample, the cytokine is IL-2.

In an example, eg, for where the condition is a viral infection, theligand (eg, antibody) comprises a gamma-4 constant region as hereindefined and optionally wherein an Fc inactivated IgG4, such aIgG4(S228P).

Determination of Specific Binding of Ligands of the Invention to PD-L1Variants

The specific binding of ligands of the invention to PD-L1 variants canbe performed using the SPR method described in Example 1.

By way of example, the invention thus provides the following aspects:—

1. A method of treating or reducing the risk of a disease or conditionmediated by PD-L1 in a human, the method comprising administering tosaid human an anti-PD-L1 ligand (eg, an anti-PD-L1 trap, antibody orantibody fragment) that specifically binds to a human PD-L1 that isexpressed by a PD-L1 nucleotide sequence comprising a variation selectedfrom the variations listed in Table 21.

For example, there is provided a method of treating or reducing the riskof a disease or condition mediated by PD-L1 in a human, the methodcomprising administering to said human an anti-PD-L1 ligand (eg, ananti-PD-L1 trap, antibody or antibody fragment) that specifically bindsto a human PD-L1 that is expressed by a PD-L1 nucleotide sequencecomprising a variation selected from the variations listed in Table 21,wherein said human comprises a PD-L1 nucleotide sequence comprising saidselected variation.

For example, there is provided a method of treating or reducing the riskof a cancer in a human, the method comprising administering to saidhuman an anti-PD-L1 ligand (eg, an anti-PD-L1 trap, antibody or antibodyfragment) that specifically binds to a human PD-L1 that is expressed bya PD-L1 nucleotide sequence comprising a variation selected from thevariations listed in Table 21, wherein said human comprises a PD-L1nucleotide sequence comprising said selected variation.

For example, there is provided a method of treating or reducing the riskof an autoimmune disease or condition in a human, the method comprisingadministering to said human an anti-PD-L1 ligand (eg, an anti-PD-L1trap, antibody or antibody fragment) that specifically binds to a humanPD-L1 that is expressed by a PD-L1 nucleotide sequence comprising avariation selected from the variations listed in Table 21, wherein saidhuman comprises a PD-L1 nucleotide sequence comprising said selectedvariation.

For example, there is provided a method of treating or reducing the riskof an inflamatory disease or condition in a human, the method comprisingadministering to said human an anti-PD-L1 ligand (eg, an anti-PD-L1trap, antibody or antibody fragment) that specifically binds to a humanPD-L1 that is expressed by a PD-L1 nucleotide sequence comprising avariation selected from the variations listed in Table 21, wherein saidhuman comprises a PD-L1 nucleotide sequence comprising said selectedvariation.

Herein, specific binding can be tested using a sample PD-L1 using aroutine method known the skilled person, eg, ELISA or SPR (eg, using amethod as described herein). For example, the PD-L1 is provided by asample from said human or another human, eg, a serum or blood sample.

In an example, the ligand comprises an anti-PD-L1 binding site thatspecifically binds human PD-L1. Optionally, the binding site comprisesone or more antibody variable domains or one or more human PD-L1receptor domains. In an example, specific binding with a Kd of 1 mm orless (ie, 1 mM or stronger binding), eg, 1 nM or less; or 100 pM orless; or 10 pM or less. Specific binding can be determined, for example,by assessing binding of the ligand to PD-L1 in a sample from said humanor another human comprising said PD-L1. In an example, the samplecomprises serum, blood, faeces, tissue, a cell, urine and/or saliva ofsaid human.

In an example, the ligand is selected from the group consisting of whereMEDI4736 (Medimmune), durvalumab, RG-7446 (Genentech, Roche, Chugai,MPDL3280A), MPDL3280A (Genentech), STI-A1014 (Sorrento TherapeuticsInc), MSB-0010718C (Merck Serono); MDX1105 (Bristol-Myers Squibb) andBMS-936559 (Bristol-Myers Squibb). Optionally the ligand is administeredin combination with an anti-CTLA-4 ligand (eg, antibody or fragment),eg, Tremelimumab. For example, MEDI4736 or durvalumab is administered incombination with an anti-CTLA-4 ligand (eg, antibody or fragment), eg,Tremelimumab.

In an example, the ligand is an anti-PD-L1 antibody or antibodyfragment, eg, durvalumab.

In an example, the ligand is an NCE (so-called New Chemical Entity inthe art).

In an example, the human has been diagnosed with said disease orcondition before said administration of the ligand.

For example, the human is partially or completely resistant to treatmentwith an anti-PD-L1 ligand, eg, an anti-PD-L1 NCE.

In an example, the ligand is administered by intravenous or subcutaneousadministration and/or is comprised in an injectable preparation.

2. The method of aspect 1, wherein the nucleotide sequence comprises anucleotide corresponding to SNP rS1411262, SNP rs4143815, 8923C or 395C.

3. The method of aspect 1 or 2, wherein said human comprises a PD-L1nucleotide sequence comprising said selected variation.

Optionally, the human is homozygous for said variation. Alternatively,the human is heterozygous for said variation.

In an example, the ligand comprises an antibody constant region (eg, anantibody Fc region).

4. The method of any one of aspects 1 to 3, wherein the ligand comprisesa human gamma-1 heavy chain constant region that comprises an amino acidselected from the group consisting of an Asp corresponding to position204 of SEQ ID NO: 42 and a Leu corresponding to position 206 of SEQ IDNO: 42 and optionally wherein said human comprises an IGHG1*01 humanheavy chain constant region gene segment, or the human expressesantibodies comprising human gamma-1 heavy chain constant regionscomprising said selected amino acid.

For example, the ligand comprises a human gamma-1 heavy chain constantregion that comprises an amino acid selected from the group consistingof an Asp corresponding to position 204 of SEQ ID NO: 42 and a Leucorresponding to position 206 of SEQ ID NO: 42 and wherein said humancomprises an IGHG1*01 human heavy chain constant region gene segment, orthe human expresses antibodies comprising human gamma-1 heavy chainconstant regions comprising said selected amino acid. In an embodiment,this is combined with any of the examples set out under aspect 1 above.

Optionally, this constant region of the ligand is comprised by an Fcregion, eg, an enhanced Fc region.

Optionally, the ligand comprises an IGHG1*01 human heavy chain constantregion.

5. The method of any one of aspects 1 to 4, wherein the disease orcondition is cancer (eg, a solid tumour), an autoimmune disease orcondition; or an inflammatory disease or condition.

In an example, the cancer is selected from the group consisting ofbreast cancer, lung cancer (eg, non-small cell lung cancer), coloncancer, ovarian cancer, melanoma (eg, stage IV melanoma), bladdercancer, liver cancer (eg, hepatocellular carcinoma), kidney cancer,salivary gland cancer, stomach cancer, gastric cancer, glioma, pancreascancer, thyroid cancer, thymic epithelial cancer, head cancer and/orneck cancer, multiple myeloma, T cell lymphoma, Hodgkin lymphoma, renalcell carcinoma, cervical cancer, colorectal, a haematological neoplasm,metastatic colorectal cancer, uterine or cervix cancer, a leukaemia (eg,acute myelogenous leukaemia), diffuse large B-cell lymphoma, folliclecentre lymphoma, prostate cancer and Merkel cell carcinoma.

Alternatively, the disease or condition is a viral infection, eg, HIV,hepatitis C or Ebola infection.

Alternatively, the disease or condition is melodysplastic syndrome.

In an example, the condition is a cancer, eg, metastatic cancer.

6. The method of any one of aspects 1 to 5, comprising, before saidadministering, selecting a human comprising said PD-L1 nucleotidesequence, wherein the human is the human of aspect 1.

7. The method of any one of aspects 1 to 6, wherein the human has beendetermined to comprise said PD-L1 nucleotide sequence.

8. The method of any one of aspects 1 to 6, comprising the step ofdetermining that the human comprises said PD-L1 nucleotide sequence,optionally, wherein the determining step is performed beforeadministration of the antibody to the human.

9. The method of aspect 8, wherein the step of determining comprisesassaying a biological sample from the human for a PD-L1 nucleotidesequence comprising said selected variation.

10. The method of aspect 9, wherein the assaying comprises contactingthe biological sample with

-   -   a. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides that can specifically        hybridize to and identify in the biological sample a nucleotide        sequence comprising said selected variation or that specifically        hybridizes to an antisense of said sequence, wherein said        nucleic acid hybridizes to said selected variation or hybridizes        to an antisense sequence thereby forming a complex when at least        one nucleotide sequence comprising said selected variation is        present; and/or    -   b. at least one oligonucleotide probe comprising a sequence of        at least 10 contiguous nucleotides of a nucleotide sequence        comprising said selected variation or comprising an antisense        sequence of said contiguous nucleotides, wherein said sequence        of contiguous nucleotides comprises said selected variation        thereby forming a complex when the nucleotide sequence        comprising said selected variation is present; and    -   detecting the presence or absence of the complex, wherein        detecting the presence of the complex determines that the human        comprises a PD-L1 nucleotide sequence comprising said selected        variation.        11. The method of aspect 10, wherein the assaying comprises        nucleic acid amplification and optionally one or more methods        selected from sequencing, next generation sequencing, nucleic        acid hybridization, and allele-specific amplification and/or        wherein the assaying is performed in a multiplex format.        12. The method of any one of aspects 1 to 11, wherein said human        is or has been further determined to be substantially resistant        a PD-L1 or PD-1 treatment.        13. The method of any one of aspects 1 to 11, wherein said human        is receiving or has received a PD-L1 or PD-1 treatment or has        reduced responsiveness to a PD-L1 or PD-1 treatment.        14. The method of aspect 9, wherein said biological sample        comprises serum, blood, faeces, tissue, a cell, urine and/or        saliva of said human.        15. The method of any one of aspects 1 to 14, wherein said human        has been diagnosed with a cancer, autoimmune disease or        condition; or an inflammatory disease or condition.        16. The method of any one of aspects 1 to 15, wherein said        ligand is administered by intravenous or subcutaneous injection        and/or is comprised in an injectable preparation.        17. The method of any one of aspects 1 to 16, wherein the ligand        is human.        18. An anti-human PD-L1 ligand (eg, an antibody, antibody        fragment or human PD-L1 trap) for use in a method of any one of        aspects 1 to 17.        19. The ligand of aspect 18, wherein the ligand is a human        anti-human PD-L1 antibody (eg, durvalumab), antibody fragment or        human PD-L1 trap.        20. The ligand of aspect 18 or 19, wherein said ligand is for        intravenous or subcutaneous administration and/or is comprised        in an injectable preparation.

For rs148170925, the 1000 Genomes Phase 1 database indicates acumulative frequency across all human populations of 60% for thedeletion (ie, presence on the SNP) and 40% for absence of the SNP (ie,presence of TG at chromosomal location 9:5454642-5454643). The followinghuman populations have above average frequency for absence of the SNP:AMR (45%), EUR (54%), ASW (44%), CLM (42%), MXL (44%), PUR (49%), CEU(60%), FIN (57%), GBR (56%), IBS (46%) and TSI (46%); in an embodimentof the invention, the human is of any one of these ancestries. Thefollowing human populations have above average frequency for presence ofthe SNP: AFR (67%), ASN (76%), LWK (77%), YRI (65%), CHB (73%), CHS(79%), JPT (75%); in an embodiment of the invention, the human is of anyone of these ancestries.

What is claimed herein is:
 1. A method of treating or reducing the riskof retinopathy in a human, the method comprising administering to saidhuman an anti-VEGF-A ligand that specifically binds to a human VEGF-Athat is expressed by a VEGF-A nucleotide sequence comprising a SNPselected from the group consisting of: rs699947; rs833061; rs2010963;rs3025039; rs699946; rs2146323; rs1413711; rs833068; rs833069; rs3025000and rs1570360; wherein the ligand comprises a human gamma-1 heavy chainconstant region that comprises an amino acid selected from the groupconsisting of: an Asp corresponding to position 204 of SEQ ID NO: 42 anda Leu corresponding to position 206 of SEQ ID NO: 42; and wherein saidhuman comprises (i) an IGHG1*01 human heavy chain constant region genesegment, or the human expresses antibodies comprising human gamma-1heavy chain constant regions comprising said selected amino acid and(ii) a VEGF-A nucleotide sequence comprising said selected SNP.
 2. Themethod of claim 1, wherein the ligand is an anti-VEGF-A trap; antibody;or antibody fragment.
 3. The method of claim 1, wherein the retinopathyis diabetic retinopathy (DR) or retinopathy of prematurity (ROP).
 4. Themethod of claim 1, wherein the SNP is selected from the group consistingof rs699947, rs833061, rs2010963, rs3025039 and rs699946; optionallywherein the human is homozygous for said SNP.
 5. The method of claim 1,wherein the SNP is selected from the group consisting of rs699947,rs2146323, rs1413711, rs699946, rs833068, rs833069 and rs3025000;optionally wherein the human is homozygous for said SNP.
 6. The methodof claim 1, wherein the method further comprises treating the human withphotodynamic therapy.
 7. The method of claim 1, wherein the humancomprises A: (a) a HTRA1 nucleotide sequence comprising SNP rs11200638;(b) an ARMS2 nucleotide sequence comprising SNP rs10490924; (c) a CFHnucleotide sequence comprising SNP rs800292, a T at the position ofrs1061170 or an A at the position of rs3766404; (d) a complementcomponent 2 (C2) nucleotide sequence comprising SNP rs547154; (e) aprothrombin nucleotide sequence comprising SNP rs1799963; (f) a MTHFRnucleotide sequence comprising SNP rs1801133; (g) a Factor V nucleotidesequence comprising SNP rs6025; or (h) a VEGFR2 nucleotide sequencecomprising SNP rs4576072 or rs6828477; or B: (a′) a HTRA1 nucleotidesequence comprising SNP rs11200638; (b′) an ARMS2 nucleotide sequencecomprising SNP rs10490924; (c′) a CFH nucleotide sequence comprising SNPrs800292; or (d′) a complement component 2 (C2) nucleotide sequencecomprising SNP rs547154; or C: (i) an ARMS2 nucleotide sequencecomprising a G at the position of SNP rs10490924; (ii) a CFH nucleotidesequence comprising a T at the position of SNP rs1061170 or rs3766404;(iii) a prothrombin nucleotide sequence comprising SNP rs1799963; (iv) aMTHFR nucleotide sequence comprising SNP rs1801133; (v) a Factor Vnucleotide sequence comprising SNP rs6025; or (vi) a VEGFR2 nucleotidesequence comprising SNP rs4576072 or rs6828477.
 8. The method of claim1, wherein the ligand comprises an IGHG1*01 human heavy chain constantregion.
 9. The method of claim 1, comprising, before said administering,selecting a human comprising said VEGF-A nucleotide sequence of (ii),wherein the human is the human of claim
 1. 10. The method of claim 1,wherein the human has been determined to comprise said VEGF-A nucleotidesequence of (ii).
 11. The method of claim 1, comprising the step ofdetermining that the human comprises the nucleotide sequence of (ii),optionally, wherein the determining step is performed beforeadministration of the antibody to the human.
 12. The method of claim 11,wherein the step of determining comprises assaying a biological samplefrom the human for a nucleotide sequence of (ii).
 13. The method ofclaim 12, wherein the assaying comprises contacting the biologicalsample with a. at least one oligonucleotide probe comprising a sequenceof at least 10 contiguous nucleotides that can specifically hybridize toand identify in the biological sample a nucleotide sequence comprisingsaid selected SNP or that specifically hybridizes to an antisense ofsaid sequence, wherein said nucleic acid hybridizes to said selected SNPor hybridizes to an antisense sequence thereby forming a complex when atleast one nucleotide sequence comprising said selected SNP is present;and/or b. at least one oligonucleotide probe comprising a sequence of atleast 10 contiguous nucleotides of a nucleotide sequence comprising saidselected SNP or comprising an antisense sequence of said contiguousnucleotides, wherein said sequence of contiguous nucleotides comprisessaid selected SNP thereby forming a complex when the nucleotide sequencecomprising said selected SNP is present; and detecting the presence orabsence of the complex, wherein detecting the presence of the complexdetermines that the human comprises the nucleotide sequence of (ii). 14.The method of claim 12, wherein the assaying comprises nucleic acidamplification and optionally one or more methods selected fromsequencing, next generation sequencing, nucleic acid hybridization, andallele-specific amplification and/or wherein the assaying is performedin a multiplex format.
 15. The method of claim 1, wherein said human isor has been further determined to be substantially resistant tosunitinib, bevacizumab or ranizumab treatment.
 16. The method of claim1, wherein said human is receiving or has received sunitinib,bevacizumab or ranizumab treatment or has reduced responsiveness tosunitinib, bevacizumab or ranizumab treatment.
 17. The method of claim12, wherein said biological sample comprises serum, blood, faeces,tissue, a cell, urine and/or saliva of said human.
 18. The method ofclaim 1, wherein said human has been diagnosed with an ocular condition,optionally DR or ROP.
 19. The method of claim 1, wherein said ligand isadministered by intraocular injection or by topical administration tothe eye and/or is comprised in an injectable preparation or topicalocular preparation.
 20. The method of claim 1, wherein the ligand ishuman.
 21. The method of claim 2, wherein the ligand is human.
 22. Themethod of claim 1, wherein the method comprises administering ananti-PDGF-B or anti-PDGFR-B ligand to the human simultaneously orsequentially with the anti-VEGF-A ligand.
 23. The method of claim 22,wherein the anti-PDGF-B or PDGFR-B ligand is an anti-PDGF-B or PDGFR-Bantibody or fragment, an anti-PDGF-B or PDGFR-B trap or an anti-PDGF-Bor PDGFR-B aptamer.
 24. The method of claim 1, wherein the methodcomprises administering an anti-Ang2 or anti-Tie2 ligand to the humansimultaneously or sequentially with the anti-VEGF-A ligand.
 25. Themethod of claim 1, wherein the human is greater than 60 years of age.26. The method of claim 1, wherein the human is suffering from type Idiabetes.
 27. The method of claim 1, wherein the human is suffering fromtype II diabetes.
 28. The method of claim 2, wherein the trap is aligand comprising first and second VEGF-A receptor domain sequencesfused to a human gamma 1 heavy chain constant region.